Hilary Atkinson, MS Nurse Specialist Queens Nurse Theresa Wager, MS Specialist Occupational Therapist

1. Understanding PiP
Personal Independent Payment
Hilary Atkinson, MS Nurse Specialist
Queens Nurse
Theresa Wager, MS Specialist
Occupational Therapist

2. Aims and Objectives
End of the session –
• Understand the impact of PiP assessments on
People living with Multiple Sclerosis (PLWMS)
• Identify how you as, MS specialists, can
support PLWMS applying for PiP in a time
efficient way
• Know where to sign post PLWMS for more
help with PiP assessments

4. Eligibility
• 16 to the individuals state pension age – this varies and need to look at
the calculator on DWP site
• Have a Health Condition or Disability where you -•have had difficulties
with daily living or getting around (or both) for 3 months
• expect these difficulties to continue for at least 9 months (unless you’re
terminally ill with less than 6 months to live)
• You must have lived in England, Scotland or Wales for at least 2 of the last
3 years, and be in one of these countries when you apply. If you’ve
recently returned from living in another EEA country, you might be able to
get PIP sooner.
• The process is different in Northern Ireland.
• You can get PIP whether you’re working or not.
• You cannot get PIP and Armed Forces Independence Payment at the same
time.
• There are additional rules if you live abroad or if you’re not a British citizen
• Comprised of two sections - Care & Mobility

5. PiP - 2 components
• Care – Activities of daily living, physical and
psychological issues – comprising of 10
questions – must score 12 points for full
benefit in care component
• Mobility – comprising of 2 questions max 12
points for full mobility component

6. Impact of PiP Assessments
Impact on PLWMS
• Raising Stress and Anxiety
• Stress of loosing DLA and more
importantly the car
• Acknowledging their disability
• Negative impact on their health
and well being
• Mobility
• Appeals
• Stress and anxiety may trigger MS
Relapse/ exacerbate MS
symptoms
• Family stress – financial
• Reassessment process and sense
of loss
How can we lessen this impact
• Honesty – encourage family to assist
in completing the form
• Explain that is a negative process to
prepare them as it is about every
they are not able to do
• Discuss their mobility and explain the
PiP process, if you feel that they
would benefit form a wheel chair
when out then document that.
‘Wheel Chairs are enablers’
• Activities of Daily Living – ADL
• Fatigue
• Write and effective care plan/letter
when in clinic

7. How we can help and support
PLWMS
• Use clinic time effectively
• Keep ADL and mobility in mind – use assessment
tools
• Write clear clinic letters/care plans as supporting
evidence when seeing PLWMS in clinic
Process - when receive PiP application
• Request extension date - tele number from PiP letter
• Advise PLWMS to access Citizens Advice to help
complete forms
• Use care plan / clinic letter and any assessments as
evidence

8. Mobility
DWP advice
• Base your answer on what distance you can
manage most of the time (that is, on a
regular and repeated basis) with or without
an aid, such as a walking stick.
• Don't overestimate your ability. For example,
if you can't regularly and repeatedly walk 50
metres then don't say you can.
• If pain and breathlessness affect how far you
walk, take that into account.
• You should probably tick "less than 20
metres" if you can't stand up or walk
From DWP website
DWP guidance
• To give you a rough idea of
distance:
• 20 metres is the length of 2
buses
• 50 metres is the length of 5
buses
• 200 metres is the length of
20 buses
From DWP website

9. ‘Good days Bad days’
prefer to use ‘MOST’ days
Good bad days
• Explain how you cope on both good days and bad
and how you manage over a longer period of time
(like a week). This gives the DWP a better picture of
how you cope most of the time.
• Make it clear:
• •if you have good days and bad days
• •how often you have bad days
• •if you have bad days more often than not
• •how your difficulties and symptoms differ on good
days and bad - for example, you can't walk as far or
stand at all or the level of pain you feel is greater
• It's ok to estimate your bad days but say if you are.
If it's too difficult to estimate - explain why. For
example, because your condition fluctuates.
From DWP website
Prefer to use
Use the term ‘most days’
Fatigue
Pain
Spasticity
Function
Continence
Psychological
Cognition

10. Useful examples of Assessment Tools
cognitive assessments, depression and anxiety , MS tools
others - Health needs assessment - HNA

11. Example of cognitive assessment

12. Signposting - Websites and resources
• Personal Independence
Payment (PIP) - GOV.UK
https://www.gov.uk/pip
• Citizens Advice
• Family /friends
• MS Trust and MS
Society
• MS team can provide
invaluable evidence
when writing our clinic
/care plan letters

13. Example of our Care plan letter
format
• Addressed to PLWMS – GP/Consultant copied in
• Letter referred to as a care plan ‘We discussed a
number of issues that I have written as per your care
plan; ‘
• List as Headings issues discussed eg
‘Bladder – you currently use Intermittent catheters to
manage bladder function…’
‘Mobility – you rely on others assisting you in your
wheel chair when out side but are able to furniture
walk in your home’

14. Case Study A

15. Case study B

16. PiP assessor
• I decided
• Based on available
evidence
• I decided you can

17. summary
• Do concise Care plan /letter
• Advise – to look at form on line
• When form arrives it gives a 2 week deadline – phone number
on form request an extension.
• Once have extension number contact Citizens advice to
request appointment to complete PiP application
• Take all clinic letters, cognitive assessments, depression and
anxiety forms/reports.
• Put MS specialist Nurse/OT as a point of contact – OFFICE
number
• If you are contacted there is a tight time frame to respond so
document when the team was first notified

18. Any Questions ?

19. references
• DWP website - https://www.gov.uk/pip
• https://www.macmillan.org.uk/ Health Needs
Assessment
• Montreal Cognitive Assessment Tool
• PHQ9 GAD7

20. Thank you
hilary.atkinson3@nhs.net
t.wager@nhs.net