From: Macleod Robyn (NHS FORTH VALLEY) [robyn.macleod@nhs.net]
Sent: 10 February 2011 14:45
To: DWP Consultation DLAReform
Subject: ReACH Forth Valley

To Whom this may concern:

We form part of a community  mulitdiscplinary rehabilitation team. We assess and treat individuals with a physical disability and/or brain injury.
Please find our comments in answer to your questions:

Question 1
  a.. physical impairments, 
  b.. sensory impairments, 
  c.. cognitive impairments, 
  d.. psychological and mental health impairments.  
  e.. Financial difficulties, 
  f.. difficulties accessing and/or availability of public transport, 
  g.. physical access to buildings and/or services
  h.. need for care (professional or otherwise) at home and out and about
  i.. employment difficulties
  j.. lack of community resources
Question 2

we think you have captured everything.



Question 3

  a.. transport 
  b.. care 
  c.. housing and adaptations/equipment 
  d.. childcare costs 
  e.. disabled people generally speaking have less income that non-disabled people so they are disadvantaged financially in general terms
Question 4

Having 2 components will make the benefit easier to administer and understand, but by removing a level, it decreases its sensitivity in terms of appropriate levels of support.



Criteria for all levels needs to be very clear.



Question 5

All claims should be individually assessed but in conditions where there is a known quick progression and poor prognosis i.e. motor neurone disease, there should be a way of fast tracking the application - similar to what already happens with DLA with individuals who have a diagnosis of cancer and who are not likely to live for longer than 6 months.



Question 6

This will vary greatly according to the individual - what's important to one individual may not necessarily be important to another individual. However from a professional point of view, we would suggest the main areas of functional importance in every day life would be:

  a.. personal activities of daily living 
  b.. domestic activitites of daily living 
  c.. community and social integration 
  d.. communication 
  e.. mobility and transfers 
  f.. leisure/hobbies 
  g.. work/vocation/education
Question 7

Asking the appropriate questions about the condition and its functional implications. Asking about the "hidden" symptoms and their implications in daily life - cognition, fatigue, mood, sleep patterns/difficulties, behaviour. 

Asking the correct people the correct questions - ask the individual who they want to be in the assessment process - this could be a professional or friend or close family member - whoever the individual thinks knows them best.



Question 8

Yes, all pieces of equipment should be taken into account and their usefullness in day to day life for the individual. 

Ask the professional involved with the individual, or the family member or friend or other nominated person who knows the individual best,  about other equipment issues - what has been trialled before, why was it not succcessful etc.  It is not the remit of the DWP to comment on or make recommendations as to what equipment may be helpful to a patient - there are too many factors to consider that need addressed by a professional. In addition, funding and eligiblity criteria will differ throughout the country, and indeed from region to region. 



Question 9

To make the claim form easier to fill in:

  a.. An example of a completed form that gives all required inforamation could go out with the application pack to let the individual see what kind of info is required, and how to complete the assessment. 
  b.. less repetitive questions 
  c.. shorter assessment form 
  d.. use "lay-man's" terminology
To improve info about the new benefit, market and publicise the new benefit widely and concisely  - a single sheet stating:

  a.. what the benefit is, 
  b.. who may be entitled to it 
  c.. who isn't entitled to it 
  d.. how to apply, 
  e.. phone number to call to get further info
Distribute to social work depts, GP surgeries, hosptials schools, day centres, community resources/facilities etc



Question 10

See question 7 also.  Getting accurate and relevant information form the person/people who knows the individual best is crucial. This person should be nominated by the individual, however with the individual's consent, any professional involved with them should be routinely contacted too. 



Question 11

Benefits:

  a.. potentially more information including observation and objective information.  However this will depend upon the knowledge and expertise of the healthcare professional. 
  b.. it should provide good information on a condition and how it is affecting the individual's everyday function -  again this will depend greatly on the healthcare professional's knowledge and understanding of any given condition. 
  c.. it would be beneficial to have a pool of professionals with different clinical expertise to ensure the correct professional with the appropriate knowledge is making the assessment.
 Difficulties:
  a..  anxiety provoking for the individual
  b..  difficult to get clear picture of difficulties unless you are in the individual's own envrionment (ie how can you properly assess activities of daily living in a meeting?)
  c..  time consuming
  d..  will slow down the process - adding another level to application process.
  e.. transport difficulties for many individuals
It would be appropriate to see a client at home if they are unable to leave the house for whatever reason.
If there is enough objective information from other professionals to make a decision a face to face meeting wouldn't be required.
Individuals with a poor prognosis shouldn't have to participate in a face to face meeting.

Question 12:
Evidence:
- diagnosis, progressive and or degenerative nature of condition, prognosis, treatments that may affect functional outcome of a condition (e.g. disease modifying therapies, rehab programmes)
Types of review:
- needs to be looked at on an individual basis.  Could consider phone reviews, letter review or face to face review. Should also consider reviews with professional or nominated person where this would be in the best interest of the individual and where consented to by the individual.

Question 13:
- Regular correspondence - send out a letter or questionnaire every 6 months asking about any changes in circumstances. If so this would be the trigger for a more detail review.
- Media education - radio adverts (like tax credits)
- Educate professionals
- Posters in GP surgery / social work departments / hospitals etc.

Question 14:
-What facilities are availablie locally -  
  a.. social work departments, 
  b.. social/support groups, 
  c.. community rehab teams, 
  d.. volunteer centres, 
  e.. further education, 
  f.. care agencies, 
  g.. disabled living centres, 
  h.. self-management groups, 
  i.. citizens advice bureau.  

Question 15:
DWP could provide information on services but should not make this a requirement.  Its too big an area to comment on any further.

Question 16:
Currently if not provided by NHS or social work,  equipment/adaptations need to be self-funded.  
Yes they should be able to use their benefit to meet the costs of equipment.
This is a complex area and we are unclear regarding the DWP plans in this area from reading the document.

Question 17:
  a.. Changing needs over time (e.g. physical and developmental changes, may need multiple and changing pieces of equipment due to growth).  
  b.. Educational needs.  
  c.. Peers/socialisation is important for development.

Question 18:
At present DLA has not been particularly helpful in automatically passporting people to entitlement for other services.  What would be useful would be, along with the individual's letter of entitlement, enclosing a list of what they can now also access and how to go about doing so.

Question 19:
Lots of duplication and bureaucracy regarding assessments and applications for services.  Extra time, lengthy waits.  Individuals would 'not bother'.

Questions 20:
As much sharing of information between agencies as possible being mindful of course of data proection regulations.
Avoid duplication and bureaucracy by using existing data held on an individual ie demographics, medical history, relevant information already gathered from other claims for benefits.  However, this should not replace a robust, sensitive and holistic assessment that will be required to capture the complex issues that individuals face. 

Question 21:
It shouldn't have an influence on this.

Question 22:
It is really important that the assessment is holistic and inclusive and asks the appropriate people the appropriate questions.  For example the ESA assessment does not gather the correct information to make an informed decision about the area that it is looking at, as a result many vulnerable and significantly impaired individuals are being deemed fit for work when this is not the case.  In the majority of cases our professional opinion is not saught as part of the assessment procedure.  
It is important that we are consulted during the assessment process for PIP.  

We hope these comments are helpful  and considered in the next stages and look forward to being updated in due course,

With kind regards,

Robyn MacLeod (senior occupational therapist)
Grace Jamieson (senior occupational therapist)
Denise Wilkinson (rehab specialist nurse)


Robyn MacLeod
Senior Occupational Therapist
ReACH Forth Valley
Falkirk Community Hospital
01324 616068/07775824550

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