The role of observation in the Personal Independence Payment assessment
An aspect of the Personal Independence Payment (PIP) assessment that is sometimes misunderstood is how informal observations are taken into account. The PIP Assessment Guide, produced by the Department for Work and Pensions (DWP), is very explicit about this (we have included the relevant extract at the end of this item).
Why do observations form part of the Personal Independence Payment assessment?
Informal observations form part of the PIP assessment because they can add to the information that is available to the Health Professional (HP) for them to be able to provide a report to the DWP. They may, for example, indicate that you have problems that you haven’t referred to elsewhere, or give a clearer indication of how you are affected by certain aspects of your health condition or disability. It is important to remember that PIP is concerned with how your daily life is affected by your health condition or disability rather than the disability or health condition itself.
Observations will only be made by the HP while they are with you during a face-to-face consultation. They won’t be made through things such as CCTV or observation of the car park through a window. They also won’t be done by anyone other than the HP, such as a receptionist.
How observations are used in the Personal Independence Payment assessment
If you are observed to do something by the HP it does not mean that they will assume that you can always do that. The PIP assessment takes into account that some conditions can fluctuate, and that whether you can do something reliably, safely and repeatedly is important.
HPs will always consider informal observations in the context of fluctuations in someone’s health condition. However, if the observations are inconsistent with what has been claimed in the ‘How your disability affect you’ form then the HP will have to use their objective judgement about what weight to apply to them.
We know that some people are advised by others to explain how they are affected by their health condition or disability as if every day is like their worst. If you say in your ‘How your disability affects you’ form that you can never complete a particular task, but you are then seen doing so by the HP, this may be viewed as inconsistent. If your health condition fluctuates you are always better explaining how it fluctuates in terms of things like good days versus bad days per week or per year.
Extract from the DWP PIP Assessment Guide, 27th May 2014
- 2.6.24. Throughout the consultation, the HP should be making informal observations and evaluating any functional limitations described by the claimant. Informal observations start from “meeting and greeting” (where HPs may be able to observe the claimant’s appearance, manner, hearing ability, walking ability) and continue throughout history taking. The claimant’s mood, powers of concentration and ability to stand, sit, move around freely and use their hands should be observed. They may also be observed performing activities such as bending down to retrieve objects such as a handbag on the floor beside them, or reaching out for an object such as their medication.
- 2.6.25. HPs may note how claimants stand and mobilise to any examination couch and observe the ease with which they get on and off the couch. How does the claimant remove their clothes or shoes? Informal observations should be recorded in the report, for example: “I observed the claimant… and they appeared to have no difficulty with…”; “I saw the claimant lean heavily on a walking stick to cover the distance to the consulting room”.
- 2.6.26. The HP should note any aids or appliances in evidence, such as a walking aid, and the extent to which they are used during the consultation. Aids are devices that help a performance of a function, for example walking sticks or spectacles. Appliances are devices that provide or replace a missing function, for example artificial limbs, wheelchairs, or collecting devices for stomas.
- 2.6.27. 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 observation should apply.