Observations as part of a Personal Independence Payment consultation
An aspect of the Personal Independence Payment (PIP) consultation 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 consultation?
Informal observations form part of the PIP consultation 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 consultation?
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 consultation 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, 17th September 2020
- 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.
- 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’.
- 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.
- 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.
- 1.6.35 HPs must also take into consideration the invisible nature of some symptoms such as fatigue and pain which may be less easy to identify and explore through observation of the claimant. HPs should be mindful that the level of analgesia used does not necessarily correlate with the level of pain. GPs are encouraged to avoid prescribing strong painkillers for long-term pain as the harms usually outweigh the benefits and there could also be specific reasons why painkillers are not prescribed, for example intolerance, or the use of other methods of pain relief. When pain is a significant symptom we would expect the claimant to be able to describe the location, type, severity and variability of the pain they experience and the impact it has on their daily life. The HP can assess the disabling effect of the pain by considering such description (where applicable) along with all other aspects of the case, for example disease activity/severity, effect on daily activities, treatment, pain relief, pain management strategies, examination findings and informal observations.