What PIP means for the health sector
Updated 3 April 2023
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Overview
Personal Independence Payment (PIP) was introduced on 8 April 2013. It began to replace Disability Living Allowance (DLA) for new claims from people aged 16 to 64 (or the day before they reach State Pension from 6 December 2018 onwards). DLA remains for children up to the age of 16 and existing DLA recipients who were age 65 or over on 8 April 2013.
PIP contributes towards the extra costs associated with a health condition or disability. It is assessed on the claimant’s ability to undertake a range of activities rather than the condition they have.
People can claim and receive PIP whether they are in or out of work and it is not taxed or means tested. It can be useful in helping disabled people move into, or stay in work.
How the change from DLA to PIP affects the health sector
The health sector plays an important role in PIP, as it does in DLA. The main changes are:
- claimants are only required to send in evidence they already hold – they are not told to contact their GP or other health professional to obtain further evidence
- there is no requirement for a statement from a GP or other health professional on the PIP form
- it may be necessary to provide factual information, but it will be the assessment providers who will contact your organisation rather than the Department for Work and Pensions (DWP)
What your organisation may need to do to support a PIP claim
When a factual report is necessary, an assessment provider will contact health or social care professionals to request one to inform the PIP assessment. Factual report guidance is available on the GOV.UK website. It may be necessary for an assessment provider to contact health or social care professionals by phone where they’ve not received a report or need to clarify points on a completed report.
A SR1 report form is used to give evidence about a claimant’s medical condition, to support a claim if the claimant has been told by their doctor or a medical professional has said they might have 12 months or less to live. Medical report guidance is also available on the GOV.UK website. It may be necessary for an assessment provider to contact health or social care professionals by phone if a SR1 is not available or there are questions about it, in order to progress a claim quickly.
Patient consent
In line with GMC guidelines, assessment providers will only contact health or social care professionals where the patient’s consent is held. DWP will not contact health or social care professionals in relation to a PIP claim – instead it will be: Independent Assessment Services in London, Southern England, Scotland and Northern England; or Capita Business Services Ltd in Wales and Central England. A map of the postcode areas Capita Health and Wellbeing and Independent Assessment Services cover is available on the GOV.UK website.
PIP claims process
New claims are made by phoning 0800 917 2222 (text phone 0800 917 7777). Claimants (who aren’t applying under the special rules for end of life) are then sent a form ‘How your disability affects you’, which they complete and return with any supporting evidence they already hold.
The PIP assessment considers the effect of a health condition or disability on daily living and mobility activities. This includes the individual’s ability to: prepare and eat food; manage personal care needs; communicate and engage with other people; make decisions; and get around.
The assessment looks at how well individuals can complete the activities, whether they need to use aids and appliances and whether they need help from another person. Help includes supervision, prompting or physical assistance. The assessment also considers whether claimants can carry out activities safely, to an acceptable standard, repeatedly and in a reasonable time period. This is in legislation.
This information is considered by an assessment provider who may request further evidence from a relevant health professional or someone who supports the claimant and may arrange a face-to-face consultation with the claimant.
DWP uses all this information to decide if PIP can be awarded, at what rate and for how long.
Special rules allow people who might have 12 months or less to live to get help quickly
There are special rules for claimants who have been told by their doctor or a medical professional that they might have 12 months or less to live. They or someone supporting them should call the claims number above and submit a SR1 report to support their claim. Both the daily living component of PIP and, providing the conditions are met, the mobility component will be paid straight away. Claimants who meet the criteria:
- will not have to complete the form ‘How your disability affects you (there are extra questions on the initial call to claim instead)’
- will not need a face-to-face consultation
- are guaranteed an award of the enhanced rate of the daily living component of PIP without having to wait until they satisfy the qualifying period or prospective test
Those claimants who are already in receipt of DLA under special rules will only be invited to claim PIP when their DLA award expires. This includes children reaching age 16 who would otherwise have to claim PIP.
If some existing DLA claimants contact DWP after 28 October 2013 to say that their condition has deteriorated and have been told by their doctor or a medical professional that they might have 12 months or less to live, they will be invited to claim PIP under the special rules for end of life (see the timetable for PIP replacing DLA).
Claimants in hospital or care homes
PIP daily living component ceases to be payable after 28 days of care home residency where the costs of the accommodation are met from public or local funds. PIP mobility component can continue to be paid. People who fully self- fund their placement are unaffected by these rules. If a claimant is in a care home at the date of entitlement, PIP daily living component is not payable until they leave.
Both PIP daily living and mobility components cease to be payable 28 days after a claimant is admitted to an NHS hospital. DWP won’t usually pay PIP when claimants are in hospital but will pay when they leave. However, DWP will pay PIP if a claimant is a private patient and paying without NHS help.
DWP may also pay PIP if claimants are claiming because they are near end of life and are in a hospice.
More information about this and how periods are linked can be found in the PIP handbook.
More information
Please direct claimants to more information about PIP, including when they may be affected.
Visit the PIP tookit for up-to-date information to adapt for your organisation’s guidance and communications, including specific information for the health professions.