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

NHS Trust

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:

I feel so low I cannot start to cook

I can only manage convenience
things
I cannot concentrate to get everything I forget to check the sell by date on
ready at the same time food
I cannot concentrate to follow a I suffer panic/anxiety attacks that stop
recipe me from cooking
I am easily confused or distracted I worry that I will poison myself if food is
and may leave pots and pans boil not cooked properly
away My medication makes me
I let things burn/burn myself sleepy/forgetful
I may forget what I am doing and My medication makes me
start to do something else shaky/unsteady

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 have little or no appetite I binge on food then make myself sick

I need encouragement to eat I take diuretics/laxatives after eating
regularly I constantly think about food and the
I have an eating disorder effect it has on me
I do not eat for days I want to harm myself/I feel
I think people are trying to poison me disgusted/depressed after eating
I have certain rituals concerning I get upset by the mess I want to
meals clean up before I have eaten
I do not have mealtimes I get too anxious/excited to eat
I feel too depressed/tired/lethargic to I avoid eating meals
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
peoples 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:

I forget if I have taken my medication My medication makes me feel

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
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

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 need motivation/encouragement to I feel the need to wash/bathe/shower

get very often
washed/bathe/shower/shave/clean I have to do things a certain way and
my teeth a certain number of times
I forget to wash/bathe I scrub my skin red raw/until it is sore
I hate (certain parts of) my body My medication makes me sweat so I
I do not wear /cannot get rid of have to wash more often
tampons/towels I need supervision in case I have fit
I lack self esteem or lose consciousness in the bath
I am to low to care about my personal
hygiene
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 havent woken up and experienced
problems. Other issues could be where people dont 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 have to dress/undress in a certain

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
way
I find it too much of an effort to get
dressed
I lack self esteem
I do not care what I look like
I wear baggy clothes to hide my body
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:
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
dont know well
I get scared about meeting new
people
I get easily confused when talking to
people I dont 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
dont 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 wouldnt 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.

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 youll
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 do not manage my money and find I When in manic phases I spend

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 dont plan to pay my
essential bills
money and dont 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 someones help or
assistance.

Examples of difficulties you may have:

Leaving the House Coping with being Outdoors

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
I am afraid of open spaces/crowds

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.
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 persons 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 cant 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 2
prepare or cook a simple meal
c. Cannot cook a simple meal using a conventional cooker but 2
is able to do so using a microwave
d. Needs prompting to be able to either prepare or cook a 2
simple meal
e. Needs supervision or assistance to either prepare or cook a 4
simple meal
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 2
take nutrition; or
(ii) supervision to be able to take nutrition; or (iii) assistance
to be able to cut up food
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 6
source to take nutrition
f. Cannot convey food and drink to their mouth and needs 10
another person to do so
Activity 3 Managing Therapy or Monitoring a Health Score
Condition
a. Either (i) does not receive medication or therapy or need 0
to monitor a health condition; or (ii) can manage medication
or therapy or monitor a health condition unaided
b. Needs either (i) to use an aid or appliance to be able to 1
manage medication; or (ii) supervision, prompting or
assistance to be able to manage medication or monitor a
health condition
c. Needs supervision, prompting or assistance to be able to 2
manage therapy that takes no more than 3.5 hours a week
d. Needs supervision, prompting or assistance to be able to 4
manage therapy that takes more than 3.5 but no more than 7
hours a week
e. Needs supervision, prompting or assistance to be able to 6
manage therapy that takes more than 7 but no more than 14
hours a week
f. Needs supervision, prompting or assistance to be able to 8
manage therapy that takes more than 14 hours a week

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 2
bathe
c. Needs supervision or prompting to be able to wash or 2
bathe
d. Needs assistance to be able to wash either their hair or 2
body below the waist
e. Needs assistance to be able to get in or out of a bath or 3
shower
f. Needs assistance to be able to wash their body between 4
the shoulders and waist
g. Cannot wash and bathe at all and needs another person to 8
wash their entire body

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 2
toilet needs or incontinence
c. Needs supervision or prompting to be able to manage toilet 2
needs
d. Needs assistance to be able to manage toilet needs 4
e. Needs assistance to be able to manage incontinence of 6
either bladder or bowel
f. Needs assistance to be able to manage incontinence of both 8
bladder and bowel
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 2
undress
c. Needs either (i) prompting to be able to dress, undress or 2
determine appropriate circumstances for remaining clothed;
or (ii) prompting or assistance to be able to select
appropriate clothing
d. Needs assistance to be able to dress or undress their lower 2
body
e. Needs assistance to be able to dress or undress their upper 4
body
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 2
hear
c. Needs communication support to be able to express or 4
understand complex verbal information
d. Needs communication support to be able to express or 8
understand basic verbal information
e. Cannot express or understand verbal information at all 12
even with communication support

Activity 8 Reading and Understanding Signs, Symbols Score

and Words
a. Can read and understand basic and complex written 0
information either unaided or using spectacles or contact
lenses
b. Needs to use an aid or appliance, other than spectacles or 2
contact lenses, to be able to read or understand either basic
or complex written information
c. Needs prompting to be able to read or understand complex 2
written information
d. Needs prompting to be able to read or understand basic 4
written information
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 4
people
d. Cannot engage with other people due to such engagement 8
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 2
budgeting decisions
c. Needs prompting or assistance to be able to make simple 4
budgeting decisions
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 4
avoid overwhelming psychological distress to the claimant
c. Cannot plan the route of a journey 8
d. Cannot follow the route of an unfamiliar journey without 10
another person, assistance dog or orientation aid
e. Cannot undertake any journey because it would cause 10
overwhelming psychological distress to the claimant
f. Cannot follow the route of a familiar journey without 12
another person, an assistance dog or an orientation aid

Activity 2 Moving Around Score

a. Can stand and then move more than 200 metres, either 0
aided or unaided
b. Can stand and then move more than 50 metres but no 4
more than 200 metres, either aided or unaided
c. Can stand and then move unaided more than 20 metres 8
but no more than 50 metres
d. Can stand and then move using an aid or appliance more 10
than 20 metres but no more than 50 metres
e. Can stand and then move more than 1 metre but no more 12
than 20 metres, either aided or unaided
f. Cannot, either aided or unaided, (i) stand; or (ii) move 12
more than 1 metre
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

purpose of ensuring your safety
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.