Unfortunately this could turn into a very long and very boring post, creative writing isn't a strong point, I'll be using hypothetical's throughout. Gonna attempt to help some of you who may be helping others with the PIP process into getting their head around the Guidelines which the Assessment Providers are "supposed" to follow, in my opinion the more people that call them out for ignoring their own processes and tie the AP's up in paperwork the less time the "Nurses" have to downplay the claimant's problems at a farcical assessment, for what one can only presume is their own financial gain. Again this will be a boring post, you have been warned twice now.
I am not a legal representative, healthcare professional, member of any type of authority and my posts should be taken with a grain of salt and an idealistic mind, I am just offering my views and opinions freely and like many of the other posters in this community, I am just a normal person who survived a TBI and currently trying to make sense of the senseless on a daily basis.
EDIT: This will only get longer so to avoid any "too long; didn't read" questions it is probably an idea to put this info closer to the start, this is most definitely not a replacement for actual advice. Be prepared to argue, a lot, with various departments and stand up for yourself, be prepared to question absolutely every statement and do not be afraid to ask for evidence, repeatedly, on every conversation. Probably best not to "consent" at the consultation that is arranged, probably a better idea to explain your reasons for not going to the consultation at all afterwards to the DWP. If you are uncomfortable doing any of these things then probably better to stop reading now.
Seems the APs like to lie by omission, for example, they CAN only rearrange an appointment once, and if the rearranged appointment is missed then the case is sent back to the DWP who will usually call to ask why the appointment was missed, a hypothetical response might state "that the consultation could not be attended since mobility issues prevented the claimant attending, an attempt to change to a Home Visit was requested but the AP instead arranged another Assessment Centre consultation which could not be attended." and this may be a completely acceptable reason for the rearranged appointment to be missed. The file will then be sent back to the AP who will likely arrange another consultation, this new consultation may not be suitable on a suitable date or time, or worse, still at an assessment centre. If the appointment had already been rearranged the AP are unlikely to change it again, an email to a hypothetical MP may help get answers as to why "supporting evidence has not been gathered" or a "home visit not being offered" or "the appointment not being rearranged" and so on and so forth. They work for you after all so worth asking them to have a little look at the case and find out whats happening. They'll likely be pushed to obtain a GPFR, these aren't usually worth much since they conveniently do not ask for much in the way of "Functional Ability" or "observations" which the HPs will ultimately use as a tool to deny points based on things such as how you look or whether you made eye contact or smiled initially, essentially the HP will state that cause you smiled, you have no issues mixing with others, cause you made eye contact you can communicate correctly, cause your hair was brushed you have no issues bathing or getting dressed, all of these assumptions without asking a single question or speaking to your specialists, hypothetically, and all with your consent. Sneaky.
Information is already freely available from gov.uk/government/publicati... if interested, I would never condone anybody actually try to make sense of any corporate jargon to push their own agenda, but since this is hypothetical, let's begin.
The PIP Claimant Journey states 1.1.5 Claimants currently make an application for PIP by phone and once basic entitlement conditions are established, the claimant is asked to complete the ‘How your disability affects you’ questionnaire, referred to in this guide as the ‘claimant questionnaire’. At this stage claimants are encouraged to provide any supporting evidence they already have that they feel should be considered alongside their claim information – for example evidence from a health or other professional involved in their care or treatment.
((So we can deduce that supporting evidence is, hypothetically speaking, only an encouragement and not a requirement))
1.1.6 Once the claimant questionnaire has been returned to DWP, the case is referred to an assessment provider (AP) along with any supporting evidence provided. The AP then conducts the assessment, gathering any further evidence necessary before providing an assessment report to DWP.
((1.1.6 is a logical black hole it seems, since the AP is expected to gather the evidence after they conduct the assessment, whereas everybody knows the HPs make their decision at the consultation itself in most hypothetical scenarios. but if they have already made their decision at the consultation then there is no need to gather any further evidence since the decision has already been made at the consultation, hypothetically speaking, allowing the APs assessment report to be completed and returned to the DWP. I'll move on))
1.1.7 If the claimant questionnaire is not returned and the claimant has been identified as having a mental or cognitive impairment, the claim will be referred directly to the AP for assessment. If the individual is claiming under the special rules for terminal illness (SRTI), the case is instead referred directly to the AP and dealt with as a priority.
((Pretty self-explanatory, if the paperwork ain't returned the claim is directly sent to the AP if the applicant identified during the application as having a cognitive or mental impairment, in a hypothetical world there could be blank PIP forms arriving to HPs and they would likely have to do all of the evidence gathering themselves. :sadface:))
1.1.8 Once all evidence gathering has taken place, including a face-to-face assessment with a HP where appropriate, the DWP case manager (CM) will review the claim and all evidence provided and make a decision regarding the award of benefit.
((Notice it says "Once all evidence gathering has taken place, including a face to face assessment with a HP, where appropriate". Bingo. Where appropriate, we'll continue on and come back to where it is appropriate to attend a face to face consultation, once we find it))
1.1.9 If the claimant is unhappy with the decision on their award, they have the right of reconsideration and, if a claimant disagrees with the reconsideration, they have the right to appeal to Her Majesty’s Courts and Tribunal Service (HMCTS).
((Now you know your rights, use them, common sense and justice should prevail))
So far from looking at The PIP Claimant Journey
Further Evidence is encouraged, if you have it then send it - 1.1.5
The AP are responsible for gathering Further Evidence - 1.1.6
You presumably positively identified as having a Cognitive or Mental Impairment - 1.1.7
Appropriate face-to-face consultations - 1.1.8
Appeal, Appeal, Appeal! - 1.1.9
First part down, don't worry, not all will be quoted, thankfully, but feel free to add any further interesting one's you might find, we can skip "The PIP assessment", we won't be needing it here, hypothetically.
Under 1.2 The Health Professional Role is the following:
1.2.2 The key elements of the HP’s role in PIP are to:
consider information in the claimant questionnaire and any supporting evidence provided along with it
((This is all the HP usually does, before skipping the next two steps and going straight to face to face consultations, obviously hypothetical again))
determine whether a claim can be assessed on the basis of a paper review and provide appropriate advice
((question if there is enough evidence to conduct a hypothetical paper-based review and if not then why not?))
determine whether any additional evidence needs to be gathered from health or other professionals supporting the claimant
((question why additional evidence has not been gathered?)
carry out face-to-face consultations as required
((The HP can only arrange a face to face consultation as it is required, hypothetically, but only when appropriate, interesting)
having considered all the information and evidence of the case, produce a report for DWP containing information on the claimant’s circumstances and recommendations on the assessment criteria.
((in almost all hypothetical scenarios I can think of this is the HCP report which is given to the DWP after the consultation, regardless of evidence gathering))
So 1.2.2 alone taught us that in a hypothetical world the Nurse would almost always advise a face to face consultation is necessary regardless and routinely fail to gather evidence in order to complete a paper-based review of the case, despite face to face consultations hypothetically not being appropriate or required if they were to follow their own processes.))
Moving onto "1.3 Carrying out PIP assessments" and under Initial review of case file
1.3.6 On receipt of a referral from DWP, the HP should conduct an initial review of the case file to determine whether:
further evidence is needed
((further evidence WILL be necessary, hypothetically, to correctly inform the DWP since anything else is merely hearsay and speculation, there must be reasons for evidence gathering to be routinely ignored by the HPs?))
the claim can be assessed on the basis of the paper evidence held at this point (a ‘paper-based review’)
((this part probably cannot be completed without the above step, unless strong evidence has already presented as part of the application I believe)
a face-to-face consultation will be required. If the HP decides that this is required, they should also determine any difficulties the claimant may have attending a consultation and any reasonable adjustments which need to be put in place (home visit, British Sign Language interpreter, ground floor consultation room, accessibility toilet)
((Would it honestly be reasonable to assume that the HP, hypothetically speaking, would be able determine correctly whether somebody they have never met is able to attend the consultation visit given the information already provided in the claim form? Would they be better consulting the applicants doctor for further evidence to clarify the information before proceeding further? The answer to that hypothetical question should be that it is assuredly a wise decision to do so because it would almost definitely help inform the HP's decision))
1.3.8 APs should seek additional evidence from professionals involved in supporting claimants where HPs feel that would help inform their advice. The HP should contact the most appropriate person involved in the claimant’s care. In some cases this might be a support worker or therapist rather than the GP. The HP should ideally wait for the return of any further evidence requested before deciding whether a face-to-face consultation is needed.
((Again the AP's should seek additional evidence where it would help inform their advice, hypothetically, and should wait for it's return before proceeding further.))
So 1.3.6 says the initial review by the HP should decide where further evidence is needed, whether to gather that evidence, whether there is enough evidence to conduct a paper-based review, and if not, whether it is appropriate and required to arrange a face-to-face consultation without gathering the further evidence aspect in order to conduct a paper-based review, and in the majority of hypothetical cases nobody challenges that the HP is missing the entirety of their job relating to seeking evidence, and does so, hypothetically, hundreds of times per week.
And 1.3.8 states that if it would help inform the HPs advice they should seek additional evidence from professionals, waiting for a reply before proceeding, as suggested in 1.3.6. So why are they not doing so? ((The short answer is usually always money, hypothetically, the HPs can charge for their time and reports, which they cannot do if you cannot attend the assessment or the home visit, and conversely because they are charged up front for GPFR reports and reimbursed later, and potentially because it probably becomes an exercise in giving points during the paper-based review since the Doctor is over-ruling, if you like, the HPs knowledge and opinion with Fact, as opposed to the HPs preference of a consultation where they are essentially removing points, theoretically and hypothetically any in my own opinion))
1.3.9 APs may receive referrals from DWP for claimants who have a condition which means that they need additional support from DWP and the AP during the PIP application process. In these cases, the HP will need to consider the appropriate approach to completing the assessment (paper-based or face-to-face). More information on claimants who require additional support can be found in section 1.12 of part 1.
((Very definitely possible hypothetically that a few of the readers need additional support which was hopefully mentioned during the hypothetical application process, is the nurse really considering the most appropriate approach to completing the assessment? Are you a claimant that fits into section 1.12 of part 1?
Don't go rushing ahead but 1.12.3 states "In some cases however, claimants may not be able to engage effectively with the claims process, due to reduced mental capacity or insight – for example, they may not understand or care about the consequences of not returning a claim form and may not have any support from another person who would be able to help them. In the PIP journey, such claimants are considered to require additional support from the DWP and elements of the PIP claims process have been adapted to provide further support for this group."))
1.3.11 HPs should also consider the needs of vulnerable claimants. A vulnerable claimant is defined as ‘someone who has difficulty in dealing with procedural demands at the time when they need to access a service’ .This includes life events and personal circumstances such as a previous suicide attempt, domestic violence, abuse or bereavement. If a claimant has been in contact with DWP and has threatened self-harm or suicide, information about the incident will be included in the PIPCS – Medical Evidence screen comments box.
((I am unsure if Brain Injuries class as a vulnerability although they really should, presuming some cases may fit under "life events" hypothetically))
1.3.13 If further evidence is requested and returned, a further PA1 or the relevant screen in PIPAT should be completed to inform DWP of the next steps after the review of the further evidence.
((further suggestions that the AP should hypothetically be collecting evidence to inform the DWP?))
Under 1.4 Further evidence needed section we have the following
1.4.1 Additional evidence from professionals supporting the claimant should be sought where the HP feels it would help to inform their advice to DWP. The circumstances where obtaining further evidence may be appropriate include (but are not limited to):
where HPs feel that further evidence will allow them to offer robust advice without the need for a face-to-face consultation – for example, because the addition of key evidence will negate the need for a consultation
((almost certainly further evidence would provide this and negate the need for a consultation, hypothetically, and if it does not negate the need for a consultation it will help inform the HPs "robust advice" to the DWP in any case))
where they feel that a consultation may be unhelpful because the claimant lacks insight into their condition
((I for one am not very insightful into my condition or it's effects on myself and others, and that isn't hypothetical, others maybe feel the same about themmselves))
where claimants have progressive or fluctuating conditions
((progressive or getting worse, fluctuating between good and bad, fairly certain that covers the entirety of conditions presented by anybody ever))
where they consider that a consultation is likely to still be needed but further evidence will improve the quality of the advice provided to DWP – for example, because the existing evidence lacks detail or is contradictory or to corroborate other evidence
((Boom. So dissecting their arguments is made fun now. >not enough evidence so a consultation is necessary. >lacks detail on functional aspects >contradictory to X >unable to corroborate Y = The HP should really gather more evidence if it will help improve the quality of the advice provided to the DWP first, and await it's return before arranging an assessment.))
where, in reassessment cases, further evidence may confirm whether or not there has been a change in the claimant’s health condition or disability.
((why not, if you haven't been reassessed ensure your GP is contacted when the time comes))
1.4.2 If a face-to-face consultation has already been arranged and, following receipt of further evidence, the HP concludes that they can now advise DWP on the basis of paper evidence, the face-to-face consultation should be cancelled.
((self-explanatory, if evidence gathering is enough to make a decision, the consultation should, rightfully, be cancelled))
1.4.3 If a claimant brings further relevant evidence to a face-to-face consultation which is not already on PIPCS, the HP should always consider its relevance when completing their assessment report. Under normal circumstances the HP would make copies of the original evidence and hand the originals back to the claimant. In circumstances where it is not possible to copy the further evidence, perhaps during home consultations or where the claimant does not wish to part with the evidence, then it is permissible for the HP to make notes from the original further evidence documentation. The copy of the evidence or HP notes from the evidence should be sent to the CM with the completed report.
((Again if you have further evidence send it, wouldn't trust the HP to include it since a hypothetical consensus used to be if no evidence then it is assumed you don't have the condition, unsure if that has changed or not, in any case any evidence is helpful but probably better to post it as soon as possible or email it across to the AP))
Under Sources of further evidence
1.4.4 In the claimant questionnaire, claimants are encouraged to list the professionals who support them and are best placed to provide advice on their circumstances. HPs should give consideration to the fact that in cases of complex conditions, knowledge and involvement of the GP may be limited, with specialist practitioners potentially better placed in some cases to provide useful evidence. HPs should consider which professionals identified can provide useful evidence. They should not simply request evidence from all professionals identified as standard.
((So list all your specialists and practitioners, is your hypothetical case complex, ensure they know this))
1.4.5 The HP should consider the most appropriate evidence for the case under consideration. There are various sources of further evidence, including, but not limited to:
a report from other health professionals involved in the claimant’s care such as a community psychiatric nurse (CPN)
a report from an NHS hospital
a factual report from a GP
a report from a local authority-funded clinic
current repeat prescription lists
care or treatment plans
evidence from any other professional involved in supporting the claimant, such as social workers, key workers or care co-ordinators
telephone conversations with any such professionals
information from a disabled young person’s school or special educational needs co-ordinator (SENCO)
an occupational therapist’s report
a report from an ophthalmologist
an audiologist’s report
((We can see a lot of further evidence is included, send any you have, since a report from other health professionals is an option you could also hypothetically send in any reports relating to ESA or UC since the DWP are classing those as health professionals when employing them, joy of joys))
contacting the claimant by telephone for further information.
Seeking further evidence from professionals
1.4.7 Where necessary, HPs may also seek evidence from professionals by telephone. Such telephone calls should be made by approved HPs, not by clerical staff.
((HPs hypothetically have the option to seek evidence via telephone, if there is not enough provided from the GPFR, wonderful, maybe the consultation is unnecessary too))
Seeking further information from the claimant
1.4.15 Where necessary, HPs may seek further information from claimants by telephone. Such telephone calls should be made by approved HPs, not by clerical staff.
((incredible, hypothetically, being assessed on the move, over the phone, why would a consultation be necessary then?))
1.4.16 HPs should identify who they are and the purpose of the call. A written record should be taken of any telephone discussion seeking further information, using the claimant’s own words as precisely as possible. This information should be included in the assessment report provided to DWP or via the PIPAT. The HP should always ask if there is anything else that the claimant wishes to say before concluding the call. The call should conclude by reading back what has been documented and advising the claimant that this information will be added as evidence to the file.
((If there is a team with a process to follow to call claimants up for evidence then is the consultation ever a requirement or appropriate?))
Paying for further evidence
1.4.18 APs are responsible for making payments for GP factual reports (GPFRs) where they have sought them, with the DWP reimbursing them the fees paid. DS1500s will be sought and paid for by the DWP.
((Hypothetically the largest reason GPFRs are rarely sought by the HP I'd imagine))
Late return of further evidence
1.4.19 Where further evidence is received after the assessment has been completed and returned to the DWP, the evidence must be sent to the CM for consideration. If evidence is returned to the AP in error, it should still be forwarded to the DWP for scanning.
((didn't receive a piece of evidence in time? include it anyway after the fact since it MUST be sent to the CM for consideration, hypothetically of course))
Balance of probabilities
1.5.2 In some cases there may be sufficient information to advise on the majority of activities, but which leaves small gaps that it has not been possible to fill through obtaining further evidence or by contacting the claimant. In such cases, where the available information is consistent, the HP should consider whether they can use their own expert clinical knowledge of the condition(s), its severity and known impact in other areas to determine, on the balance of probabilities, the likely impact in the remaining areas. If they feel confident doing this and it would be in line with the consensus of medical opinion, then a paper-based review may still be possible, referring to such in the summary justification.
((Hypothetical AP still claiming there is insufficient evidence? then their HP is obviously allowed to use their "own expert clinical knowledge" to fill in any hypothetical gaps by contacting the claimant, if necessary))
1.5.3 Apart from examination and informal observations that can only be obtained at a face-to-face consultation, the HP must complete the paper-based review in line with the advice given in this guidance. HPs are required to advise on:
which of the descriptors in the activities set out in the assessment criteria are relevant to the claimant, taking due consideration of variability and reliability
whether the functional impact of the claimant’s health condition(s) or impairment(s) has been present for at least 3 months and is likely to remain for at least 9 months
the appropriate time to review the claim, or indeed whether the claim will require a review, and whether the functional restriction identified in the report will be present at the point of any review
whether the claimant is likely to require additional support from the DWP in order to engage with future PIP claims processes
((Is 1.5.3 a hypothetical admittance that the sole reason for consultation is "Informal Observations" and a basic "examination", potentially so as to deny the pip claim?))
Cases that should not require a face-to-face consultation
1.5.5 Although each case should be determined individually, the following types of case should not normally require a face-to-face consultation:
the claimant questionnaire indicates a low level of disability, the information is consistent, medically reasonable and there is nothing to suggest under-reporting
((So the HP is essentially assuming you are telling the truth, hypothetically and completes a PBR))
the health condition(s) is associated with a low level of functional impairment, the claimant is under GP care only and there is no record of hospital admission. This advice applies even if the claimant maintains that they suffer from a high level of functional impairment – it is medically improbable that this is the case and a face-to-face consultation is unlikely to add much useful additional information, since the clinical examination is likely to be unremarkable
((So the HP is assuming you are lying, hypothetically, since they state medically improbable but not medically impossible and completes a PBR))
there is strong evidence on which to advise on the case and a face-to-face consultation is likely to be stressful for the claimant (for example, claimants with autism, cognitive impairment or learning disability)
((BOOM! So the face to face consultation could be hypothetically stressful to those types of claimants and a consultation should not be necessary, need to push for that evidence gathering))
the claimant questionnaire indicates a high level of disability, the information is consistent, medically reasonable and there is nothing to suggest over-reporting – (examples may include claimants with severe neurological conditions such as multiple sclerosis, motor neurone disease, dementia, Parkinson’s disease, severely disabling stroke)
((So these should also be hypothetically exempt from a consultation))
there is sufficient detailed, consistent and medically reasonable information on function.
((Probably something along the lines of Physiotherapy reports))
Cases that are likely to require a face-to-face consultation
1.5.6 For cases where there is marked inconsistency, the claimed level of disability is unexpected based on the available evidence, or it has not been possible to gain sufficient further evidence, a face-to-face consultation will be required.
((so we know that it is improbable that sufficient further evidence was sought in any case by the HP in our hypothetical scenario, so we should then know that it is still a possibility to ask them to gather sufficient further evidence in order to avoid an unnecessary and stressful consultation, since the consultation should only be required when all other methods are exhausted and where it is appropriate))
I skimmed over the face-to-face assessment part, we have already gathered it is unnecessary and inappropriate both hypothetically and theoretically given the likeliness of the claimants conditions making it unnecessary to attend a consultation, however I did decide to look at the Informal Observations and Functional Examination which mentioned above are not needed for the PBR
The only relevent piece of information contained within the face to face consultation section was the following:
"To note: It is important that the HP ensures that valid verbal consent is obtained and recorded where appropriate."
((This is hypothetically because you are agreeing to allow the "professional"s opinion to override both your own opinion and any medical or supporting evidence you might have gathered. This actually puts me in mind of that c**kwomble Iain Duncan Smith and his statement years ago that the "claimants agreed to it" when PIP first came about, which they technically did. DO NOT CONSENT!))
Informal observations
1.6.31 Informal observations are part of the suite of evidence used by CMs to help them determine entitlement to benefit. Informal observations are of importance to the consultation, as they can reveal abilities and limitations not mentioned in the claimant questionnaire, supporting evidence or during the history taking for the face-to-face consultation. They may also show discrepancies between the reported need and the actual needs of the claimant. However it is important to balance informal observations with evidence from professionals who may have observed the claimant more regularly.
((ahem, >suite of evidence? there is a plethora of actual evidence which could be gathered prior to this. >discrepancies between the reported need and the actual needs of the claimant, what is this? balance informal observations (subjective information) with evidence from professionals (factual and objective information) who have actually spent time with the claimant?))
1.6.32 The HP should be making informal observations and evaluating any functional limitations described by the claimant from the start of the consultation. The HP cannot document any observations made outwith the consultation. The consultation starts at the point the claimant enters the assessment centre or is met at their home and concludes when the claimant leaves the premises of the assessment or the HP leaves the claimant’s residence. HPs may be able to observe relevant aspects of the claimant's appearance for example how well kempt they are and whether they look under or over weight. This would be considered together with other factors such as their manner, hearing ability, walking ability during the history taking, through to the conclusion of the consultation. Informal observations should be recorded in the report, for example: ‘I observed them… and they appeared to have no difficulty with…’; ‘I saw him lean heavily on a walking stick when entering the consulting room’.
((Just wow, 'I observed them... and they appeared to have no difficulty with...'; 'I saw him lean heavily on a walking stick when entering the consulting room' are incredibly subjective and have no basis in fact, and admittedly appearance also bears no relevance to the claimants conditions, these informal observations are clearly only in place to allow the HP to subvert anything and everything, hypothetically, without the decency to back it up with actual supporting evidence. These observations are usually done INSTEAD of the evidence gathering that is supposed to happen long before this stage.))
1.6.33 HPs need be aware that it is possible that the assessment room may, for some claimants, provide an environment that appears to artificially enhance functional ability, for example for some claimants with hearing impairments. A home environment may also provide either an ideal, good or a very poor environment for testing functional ability, for example, depending on the level of background noise. HPs need to ensure that they explore claimants’ functional ability in everyday life and in a variety of environments/situations that may not be ideal.
((So this essentially looks like they're saying "Oh, the room must've artificially enhanced your functional ability, it couldn't possiply be that our HPs are lying through their teeth" hypothetically))
1.6.34 The HP’s informal observations will also help check the consistency of evidence on the claimant's functional ability. For example, there is an inconsistency of evidence if a claimant bends down to retrieve a handbag from the floor but then later during formal assessment of the spine, declines to bend at all on the grounds of pain, or if the claimant states that they have no mobility problems but they appear to struggle to walk to the consulting room. In deciding their advice, the HP will need to weigh this inconsistency and decide, with full reasoning, which descriptor is most likely to apply.
((So, essentially, in my opinion, of course, this reads as "they couldn't do the formal assessment, but i reckon they c
how to get somebody assessed
Driving assessment appointment 
Driving Assessment blues
Visual technology assessment. 
Dvla driving assessment tomorrow 
