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1. Centre for Health and Disability Assessments
The Centre for Health and Disability Assessments provides health assessments, including the Work Capability Assessments (WCAs), on behalf of the Department for Work and Pensions (DWP). The service they provide to the department is called the Health Assessment Advisory Service. Their main role is to give medical advice to help DWP decision makers reach an appropriate decision on entitlement to benefit.
1.1 Regulation and approval
Centre for Health and Disability Assessments is bound by General Medical Council, Nursing and Midwifery Council and Health and Care Professions Council codes of conduct and confidentiality. They also have to comply with strict contractual conditions relating to the handling of medical and DWP-related information.
Centre for Health and Disability Assessments is an expert in the functional assessment of disability. To undertake work for DWP, they must be approved by the Secretary of State for Work and Pensions. Initial and ongoing approval requires a healthcare professional to successfully complete an initial course of prescribed training, to comply with the requirement for ongoing training and to ensure that their work meets the requisite quality standards.
1.2 Advice from Centre for Health and Disability Assessments
Centre for Health and Disability Assessments can give telephone advice to clinicians on medical matters relating to:
- certification – such as completion of certificates and reports
- disability benefits
They are only able to offer general advice and cannot discuss individual cases of people who are being assessed for benefit. This advice service is strictly for healthcare professionals.
Centre for Health and Disability Assessments can also provide more formal educational sessions to clinicians by prior arrangement.
For general enquiries on benefit-related matters contact your local Jobcentre Plus office.
Help line for clinicians only – 0800 288 8777
2. Carer’s Credit
Carer’s Credit is available to people who do not receive Carer’s Allowance but provide care for one or more disabled people for a total of 20 hours or more each week.
The credit helps to protect the carer’s National Insurance record to make sure there are no gaps from having to undertake caring responsibilities.
There are 2 qualifying routes to be able to get Carer’s Credit, either through the disabled person being entitled to a qualifying benefit (the majority of applications) or through a certification route (Care Certificate).
2.1 When is certification required?
A Care Certificate is required when an application is made for Carer’s Credit but the person(s) being cared for is not in receipt of 1 of the qualifying benefits. The qualifying benefits are the middle or highest rate of the care component of Disability Living Allowance, the Daily Living component of Personal Independence Payment or any rate of Attendance Allowance or Constant Attendance Allowance.
Where the person(s) being cared for is not entitled to 1 of these benefits the Carer’s Credit applicant will be asked to provide a certificate signed by an appropriate health or social care professional as certifier in support of their application for Carer’s Credit. A general practitioner (GP) or someone employed directly by a GP should not normally be the first choice, because this is not within their contract.
2.2 What does the certificate confirm?
The first page of the certificate will be completed by the customer and confirms their details, how many hours of care are provided at Part 1 and details about the disabled person at Part 2.
The second page asks the opinion of the health or social care professional as to whether the disabled person mentioned at Part 2 of the Care Certificate requires the amount of care the carer states they provide each week. The certifier is asked to confirm their details and job title as well as their professional relationship to the disabled person.
The health or social care professional is not, however, asked to confirm who is actually providing the care or how much time they spend caring as they may not know the carer and this information is self certified by the customer on their application form.
2.3 Who is an appropriate health or social care professional certifier?
The regulations define the health or social care professional as a person whom the Secretary of State considers appropriate to make a declaration as to the required level of care for a person. There is no definitive list of who such a person might be and each one will be considered individually on their own merits, if necessary by contacting the individual healthcare professional concerned to clarify the situation.
The Carer’s Credit applicant is best placed to decide who to ask to complete the certificate in support of their application. This is because they should know who regularly engages with or supports the disabled person and is, by definition, the most appropriate person to assess their needs and provide the certificate confirming that the disabled person requires the amount of care being provided.
Of course the individual health or social care professional needs to feel comfortable with what is being asked of them and that they know the disabled person sufficiently well to be able to undertake the certification.
The health or social care professional that completes the certificate would normally be employed within either the health or social care community – possibly within the National Health Service (NHS), one of its contractors, or an associated organisation. However, a general practitioner (GP) or someone employed directly by a GP should not normally be the first choice, because this is not within their contract. Where possible, the carer should be encouraged to consider an alternative certifier.
Similarly the health or social care professional might be employed by a Local Authority or one of their contracted bodies.
2.4 Who else could provide the necessary certification?
Alternatively they might be employed by a voluntary (sometimes referred to as third sector) organisation which works within and represents the caring community or which works closely with the disabled person being cared for. It is also possible that local religious leaders (such as a parish priest) may be sufficiently familiar with the disabled person’s care needs to complete the certificate.
Whoever the Carer’s Credit applicant decides is best placed to complete the certificate must be familiar with the circumstances of the disabled person. This could be either because they regularly see the individual during the course of their work or because they are able to make that assessment from official records that are available to them.
It is not anticipated that the certifier will need to undertake any formal assessment or test to give an opinion about the amount of care the disabled person requires. It is hoped that the health or social care professional will be able to make a judgement as to whether the disabled person requires care and if so whether the amount of care being provided is appropriate to their needs.
2.5 What is the definition of care?
Physical illness, mental illness or general frailty may all contribute towards the need for care as may the need for social or emotional support and comfort. Care needs vary considerably from person to person. In some cases, help may be needed to perform physical tasks such as washing and dressing or cooking and cleaning. In other cases, care may be needed to stop the person hurting themselves, to help them recognise dangerous situations or to enable them to live independently.
Therefore, because care may take many forms it is important that we recognise a wide range of caring responsibilities. However, it is equally important that we take a balanced view which does not reward somebody for performing duties that would normally be considered day-to-day housekeeping such as cooking meals for their partner. Care needs should exceed what would be considered ordinary and will normally arise as a result of an illness or disability.
2.6 What the Care Certificate means and why it needs to be completed?
The certificate is potentially valuable to your customer (or their carer) because it supports an application for National Insurance credits through Carer’s Credit. Whilst there is no immediate financial benefit, these credits may ultimately help them to improve any future entitlement to a basic State Pension, State Second Pension or any Bereavement Benefits based on their National Insurance record.
2.7 What do I do if, in my judgment, the amount of care being provided is not necessary?
Simply return the certificate back to the person who asked you to complete it and say that you cannot provide the requested certification. Alternatively you can complete the certificate indicating at Part 3 that the care is not required and return it to the address shown for the Carer’s Credit team. Either way we hope that you will understand that it is important not to sign certificates if you feel unable to give an opinion about the care required as they may give significant benefit or pension at public expense.
2.8 What are the consequences of filling in the certificate?
In your role as a health or social care professional or an appropriate person within a relevant organisation, we ask your opinion whether the amount of care being given to the disabled person is appropriate to their current needs. Occasionally, it may be necessary for the department to contact you to clarify your professional position and/or knowledge of the individual or your relationship to them.
2.9 What if the person being cared for does not sign Part 2 of the certificate?
Part 2 of the certificate asks the disabled person to provide consent for the health or social care professional to disclose details of the level of care required. However, this is not essential and, if consent has not been given, it does not necessarily mean that you should not give your opinion. There may well be cases where an individual is unable to sign or it would be inappropriate or inadvisable to ask them to do so. Not everyone will recognise or want to accept that they need care. In such cases, you should use your knowledge of their circumstances to decide whether it is reasonable to complete the form without their signed consent.
2.10 What if a person’s circumstances change after the Care Certificate is signed?
We do not expect you to implement a system to check on whether a person’s circumstances have changed. We will rely on our customer who is providing care to notify any relevant changes of circumstances directly to us. Regular reviews will be undertaken to remind our customer of their responsibilities and it will be their responsibility to report changes not yours.
2.11 Can I charge a fee for signing the certificate?
We cannot prevent you from doing so. However, we hope that you will recognise the importance of these certificates to our joint customers and decide not to charge them a fee. We cannot reimburse you or our customer for any fee that you may choose to charge.
2.12 Further help and guidance
Further guidance is available in the help section of the notes included with the Carer’s Credit application pack.
Alternatively, you can call 0845 608 4321 or write to:
Carers Allowance Unit
Mail Handling Site A
2.13 Information for patients – Carer’s Credit
3. The Child Trust Fund
The Child Trust Fund (CTF) is a long-term savings and investment account for children. It ensures that eligible children have savings at the age of 18 and helps them and their parents get into the habit of saving. HM Revenue & Customs (HMRC) administer the Child Trust Fund.
3.1 How it works
Children living in the UK are entitled to a CTF account if:
- they were born between 1 September 2002 and 2 January 2011 (inclusive), and
- the first day for which Child benefit was paid for them was before 3 January 2011
In addition to government payments, family and friends can contribute up to £1,200 in total to the account each year (this will rise to £3,600 from 1 November 2011 and be indexed annually by the Consumer Prices Index from 6 April 2013 onwards).
The money in a child’s CTF account can only be taken out before the child’s 18th birthday if the child dies or is terminally ill.
4. Terminal illness
If a child is terminally ill, a person with parental responsibility may get early access to the money in a child’s account if:
- Disability Living Allowance has been awarded for the child under the Special Rules arrangements for the terminally ill, or
- other evidence of the child’s terminal illness is provided
Medical practitioners may be asked to provide information about a patient’s condition.
4.1 Information for patients – Child Trust Fund
5. Personal Independence Payment, Disability Living Allowance and Attendance Allowance
We are reviewing the information about Personal Independence Payment (PIP), Disability Living Allowance (DLA) and Attendance Allowance (AA) (October 2013).
5.1 Information for patients – PIP, DLA and AA
6. Employment and Support Allowance
We are reviewing our information about Employment and Support Allowance (October 2013).
6.1 Information for patients – ESA
7. The Financial Assistance Scheme
The Financial Assistance Scheme (FAS) may offer financial help to people who have lost out on their occupational pension if a scheme is wound up (closed down) and doesn’t have enough money to pay members’ benefits in full.
It may offer help if the employer cannot pay the shortfall because it:
- is insolvent (unable to pay its debts), or
- no longer exists, or
- no longer has to meet its commitment to pay its debt to the pension scheme in certain circumstances.
Payments to eligible scheme members can usually start at the member’s normal retirement age, with a lower age limit of age 60, but the FAS can consider early access payments on the basis of:
- ill health
- severe ill health, or
- terminal illness
7.1 Early access payments – ill health
A qualifying member may wish to consider early, reduced payments from the FAS on ill health grounds. Qualifying members can be entitled to these early access payments up to 5 years before their normal retirement age. These payments are called “ill health payments”.
To receive early, reduced, ill health payments from the FAS, an eligible member of a qualifying pension scheme must be:
- within 5 years of their normal retirement age (normal retirement age has a lower age limit of 60 and an upper age limit of 65)
- unable to work due to ill health
- likely to be unable to work due to ill health until their normal retirement age
- not already entitled to an annual payment from the FAS
It is possible to have entitlement to ill health payments from the FAS if a member is still working but has been advised that they should not work due to their ill health.
Patients applying for early access to FAS payments on ill health grounds are required to provide certain evidence. This can include:
- evidence of entitlement to relevant benefits
- a letter from a former employer
- GP’s medical certificate, for example, supplied for other reasons such as a claim for benefits or National Insurance credits
- a letter from a consultant or occupational therapist
- other details of medical treatment such a regular hospital appointments
- evidence of receiving an ill-health-related scheme pension, or
- any other evidence the applicant believes may support their application
The FAS is not able to refund any costs incurred for obtaining evidence to support applications for ill health payments.
7.2 Early access payments – severe ill health
The FAS also provides for early unreduced payments for qualifying members who are not terminally ill but have a significantly shortened life expectancy due to a progressive disease. For FAS purposes, a person is terminally ill they are suffering from a progressive disease and their death as a result of that disease can reasonably be expected within 6 months.
To receive severe ill health payments from FAS, an eligible member of a qualifying pension scheme must meet the follow conditions:
- be aged 55 or over
- unable to work due to ill health and likely to continue to be unable to work due to ill health until normal retirement age
- suffer from a progressive disease and as a consequence can reasonably be expected to die within 5 years
There is also provision for:
- an application to be made for a past period before the regulations came into force
- a survivor or relevant representative to make an application in respect of a member who may have benefited from the provisions had they not died
However there will be a limited transitional period of one year in which people may make a claim for a past period.
When a person makes a claim for severe ill health payments the FAS will issue form FAS1500SIH to the person who applied for early access on the grounds of severe ill health and ask them to arrange for the scheme member’s medical practitioner to complete it. The medical practitioner may, amongst others, include a GP, doctor or consultant from the hospital, a Macmillan Nurse, senior specialist nurse (Grade7) or similar.
The FAS needs the information requested on this form to support the application for early access payments. You may use your knowledge and the patient’s records to get the information you need. Generally, you will not need to examine the patient. The FAS needs you to give factual information. The FAS does not expect you to give a prognosis.
The FAS needs you to give sufficient information to enable another doctor to advise whether your patient has progressive disease with a significantly reduced life expectancy. You should use language that you would normally use when communicating with other doctors. The FAS is not asking you to decide whether your patient qualifies for early access to payments from the FAS.
If you are a GP then you may claim a fee for completing the form. You may be contacted again if the department needs more information about your patient.
7.3 Early access payments – terminally ill
Regulation 2 of the Financial Assistance Scheme Regulations 2005 defines ‘terminally ill’. A person is terminally ill at any time if, at that time, they are suffering from a progressive disease and their death as a result of that disease can reasonably be expected within 6 months.
This is the same definition as is used for social security benefits, for example when applying for early access to Attendance Allowance or Disability Living Allowance under the Special Rules.
When the FAS receive a request for early access payments, they will ask for evidence that the applicant is terminally ill.
Where a scheme member is entitled to Disability Living Allowance (DLA) or Attendance Allowance (AA) under the Special Rules no further evidence is needed. However, for some scheme members the Special Rules cannot be applied because, for example, they:
- are now living abroad
- are being looked after in residential care by a local authority, or are long-term hospital patients already qualify for the highest rate(s) of DLA or AA under ‘normal rules’ before they were considered to be terminally ill (so they would not gain anything by making a claim for Special Rules in DLA or AA)
- do not wish to make a claim for Special Rules in DLA or AA
When this happens the FAS will issue form FAS1500 to the person who applied for early access on the grounds of terminal illness and ask them to arrange for the scheme member’s medical practitioner to complete it. The medical practitioner may, amongst others, include a GP, a doctor or consultant from the hospital, or a Specialist Nurse (including Macmillan Nurses).
Some patients may not know the nature of their illness. So when you are asked to complete this form, please do not assume that your patient knows that they are terminally ill.
Your patient may be unaware that an application (request) for early access payments is being made.
The FAS needs the information requested on this form urgently, to support the application for early access payments. You may use your knowledge and the patient’s records to get the information you need. Generally, you will not need to examine the patient. The FAS needs you to give factual information. The FAS does not expect you to give a prognosis.
The FAS needs you to give sufficient information to enable another doctor to advise whether your patient is terminally ill. You should use language that you would normally use when communicating with other doctors. The FAS is not asking you to decide whether your patient qualifies for early access to payments from the Financial Assistance Scheme.
If you are a GP then you may claim a fee for completing the form.
7.4 More information – FAS
The Pension Protection Fund website has more information about the FAS.
8. Incapacity Benefit
9. Industrial Injuries Disablement Benefit
Industrial Injuries Disablement Benefit is a benefit for people who are disabled either as a result of an accident at work (industrial accident) or a prescribed disease. The scheme does not cover certain groups of people, for example, the self-employed, members of the armed services or some trainees.
9.1 Industrial accidents and prescribed diseases
An industrial accident is an incident or series of discrete identifiable incidents that result in personal injury. A prescribed disease is an industrial disease prescribed by regulations to be included in the Industrial Injuries Benefit Scheme. There are currently about 70 prescribed diseases. The Industrial Injuries Advisory Council is an independent body that advises the Secretary of State for Work and Pensions on whether a disease should be included in the list of prescribed diseases.
9.2 Decisions about entitlement
Non-medical decision makers collect evidence to decide on claims and make decisions about entitlement.
In a claim for an industrial accident, the decision maker collects evidence to establish if there has been an incident which is an accident for entitlement purposes. In a claim for a prescribed disease, the decision maker will establish whether the person has worked in a prescribed occupation.
If the decision maker is satisfied that the person has suffered an industrial accident or has worked in a prescribed occupation, they usually seek advice from a healthcare professional working for Centre for Health and Disability Assessments before they make a decision on the claim.
To receive benefit, a person’s disablement has to be 1% or more for certain respiratory diseases, 20% or more for occupational deafness and 14% or more in all other cases.
9.3 Claims and payments
With some exceptions, IIDB is not payable until 90 days after the accident or date of onset of a prescribed disease. However, if the person might have had an industrial accident or prescribed disease, they should make a claim as soon as possible because there are time limits to the backdating of benefit.
9.4 The role of healthcare professionals
DWP may ask the healthcare professional responsible for the clinical care of the person to provide clinical information if it is not possible to make a decision about whether to award benefit without this. DWP usually request this information by sending form BI205 (to GPs) or BI127A (to hospitals).
In a small number of cases for prescribed diseases D3 (diffuse mesothelioma) and D8/D8a (lung cancer related to asbestos exposure), the healthcare professional responsible for the clinical care of the person may be contacted by phone to request evidence in order to confirm the diagnosis. In view of the urgency of the requirement to make a decision on benefit in these cases, it would be helpful if any documentary evidence required is supplied as quickly as possible.
9.5 Information for patients – IIDB
10. Jobseeker’s Allowance
Jobseeker’s Allowance (JSA) is the main benefit for people who are out of work. Although the conditions may be relaxed under certain circumstances, to get Jobseeker’s Allowance a person must:
- be actively looking for work
- be able (and available) to work for at least 40 hours a week
- attend a Jobcentre at least once every 2 weeks to ensure they have been looking for work and that nothing has changed that could affect their claim for Jobseeker’s Allowance
10.1 The role of healthcare professionals
If a patient is unable to fulfil any of the above conditions for benefit as a result of ill health, Jobcentre Plus may request a medical certificate for verification purposes. The patient will usually ask their GP to complete a Med 3 in these circumstances.
10.2 Information for patients – JSA
11. Junior ISA
The Junior ISA scheme was introduced in 2011 for children living in the UK who were not eligible for a Child Trust Fund. Accounts do not receive any government payments but family and friends can contribute to the account in each tax year, up to a certain limit. The limit is reviewed each year.
The money in a child’s Junior ISA account can only be taken out before the child’s 18th birthday if the child dies or is terminally ill.
11.1 Information for patients
12. Mesothelioma – the 2008 Diffuse Mesothelioma Scheme
Someone suffering from the asbestos related disease, diffuse mesothelioma, may be able to get a one-off lump sum payment if their exposure to asbestos happened in the United Kingdom.
Diffuse mesothelioma cancer is linked to asbestos exposure, but asbestos is not the only cause of diffuse mesothelioma. Before the widespread use of asbestos in the 20th century it was a rare tumour, but not unheard of, and there are references to it throughout 19th century literature.
It is estimated that 1-2% of all cases of diffuse mesothelioma are not due to asbestos exposure. For example, zeolite (erionite) is a non-asbestos mineral fibre that has been identified as the probable cause of an epidemic of malignant diffuse mesothelioma in Karain, a small village in Turkey where no asbestos was found in the village.
There are other forms of mesothelioma which are not linked to asbestos exposure, for example cystic mesothelioma, which is a rare peritoneal tumour which usually occurs in women of child-bearing age, but can also occur in men, eg cystic testicular mesothelioma.
Most of those who develop diffuse mesothelioma have worked in jobs or been in environments where they have been exposed to asbestos dust particles in the air. If the illness is as a result of occupational exposure to asbestos and the person has been an employed earner, they can claim under the Industrial Injuries Disablement Benefit (IIDB) Scheme and potentially the 1979 Workers’ Compensation Scheme. However there are a number of cases of diffuse mesothelioma each year who have no occupational causation, who therefore cannot claim under the IIDB Scheme or the 1979 Scheme. The 2008 Diffuse Mesothelioma Scheme seeks to compensate this group of people.
12.2 The qualifying criteria
The qualifying criteria for the 2008 Diffuse Mesothelioma Scheme are:
- there must be evidence to show that the person suffers from diffuse mesothelioma
- the claimant must have been exposed to asbestos in the UK
- the claim must have been made within one year of diagnosis or, in the case of a claim by a dependant, within a year of the date of death
12.3 Making a claim
Claimants must provide evidence that they suffer from diffuse mesothelioma. If the claimant does not provide any evidence at all then the claim will fail.
A person who has been employed may be eligible under the Industrial Injuries Disablement Benefit (IIDB) Scheme.
If they receive IIDB they can also claim under the 1979 Compensation Scheme.
If they cannot be paid under the 1979 Scheme (whether or not they are eligible for IIDB) they may be eligible for a lump sum payment under the 2008 Diffuse Mesothelioma Scheme.
12.4 The doctor’s role in the 2008 Diffuse Mesothelioma Scheme
If your patient is diagnosed with diffuse mesothelioma:
- encourage them to claim the appropriate benefit as soon as possible
- provide documentary confirmation of the diagnosis of diffuse mesothelioma
The claim will fail if the medical evidence does not clearly say that the claimant has diffuse mesothelioma.
In a tiny number of cases, Centre for Health and Disability Assessments may contact you requesting information about or clarification of the evidence submitted by the claimant. This contact may be by phone.
You will be asked to provide Centre for Health and Disability Assessments with documentary evidence where possible, and in most cases due to the urgency of making a decision on entitlement, you will be requested to supply the information by fax if possible.
Suitable supplementary documentary evidence might include copies of hospital letters, X-ray reports, scans or biopsy results.
If documentary evidence is not available, but the diagnosis of diffuse mesothelioma has been made, verbal confirmation of the diagnosis is acceptable.
12.5 Information for patients
13. Severe Disablement Allowance
14. Statutory Maternity Pay and Maternity Allowance
Most pregnant working women and those who have very recently been employed or self-employed will be able to get either Statutory Maternity Pay (SMP) from their employer or Maternity Allowance (MA) from DWP. Both SMP and MA are paid for up to 39 weeks and to get those payments a woman must satisfy qualifying conditions based on employment and earnings.
The medical evidence is required to confirm pregnancy. This is usually on a Maternity Certificate (form MAT B1) which is issued by a registered medical practitioner (GP) or a midwife from the 21st week of pregnancy.
14.1 Information for patients
15. Statutory Sick Pay
Most employees get Statutory Sick Pay (SSP) from their employers when they are unable to work as a result of illness. SSP can be paid for a maximum of 28 weeks. Spells of incapacity separated by 8 weeks or less count as one.
For the first 7 days of incapacity a patient completes a self-certificate:
If the person is in employment and the employer does not have their own self-certification forms, the employee gives form SC2 to their employer.
The self-employed or the unemployed can claim Employment and Support Allowance straight away.
After 7 days, the patient’s employer can ask for reasonable medical evidence to support payment of SSP. The patient can obtain a medical statement confirming that their GP has advised them to refrain from work.
If the patient is still incapable of work after 28 weeks, they may make a claim for Employment and Support Allowance.