Independent Review of Adult Disability Payment: final report - summary

Annex 1: Examples of outcome-based eligibility criteria

Introduction

The outcome-based examples keep the separation of daily living and mobility components and assume keeping a points-based system although in this example no points are allocated to any activity.

The example also includes the “reliability” criteria: that a person must be able to undertake an activity safely, to an acceptable standard, repeatedly and in a reasonable time.

Daily living

Making a healthy meal and enjoying a healthy and nutritious diet

The person has access to food and drink to maintain nutrition and are they able to prepare and consume the food and drink without any help.

They can shop for ingredients, can read or understand labels and nutritional values and understand the labelling on food packaging and understand the nutritious value of different foods, and they can prepare and cook a healthy meal without any help or assistance.

Can the person safely use an oven, hob, microwave, air fryer, slow cooker and other kitchen appliances to effectively produce a healthy meal?

Can they safely access food or utensils from cupboards and safely move around the kitchen?

Can they safely clear up, wash up and put away after a meal?

Do they need to use an aid or appliance to be able to eat food safely and effectively; or

• supervision to be able to eat; or
• assistance to be able to cut up food or
• need a therapeutic source such as tube feeding to be able to take nutrition?

Do they need prompting, or support or medical intervention to be able to manage a healthy and nutritious diet, to eat a prepared meal, to shop for ingredients and/or to prepare or cook a healthy meal?

If the person is eating a restricted or unhealthy diet (e.g. only eats toast) it may be because:

• they have difficulty in getting to the shops to buy food
• they do not understand what constitutes a healthy diet for them.

Can they convey food and drink to their mouth, or do they need another person to do so?

Does the person have swallowing problems?

The person has an eating disorder or another cognitive impairment such as dementia which results in them not regularly realising any benefit from eating.

Does their ability to prepare a meal impact on their ability to carry out other tasks due to fatigue, for example?

Managing a health condition

The person does not receive medication or therapy to monitor a health condition, or they can manage medication or therapy or monitor a health condition without any help.

The person needs to use an aid or appliance to be able to manage medication or they need supervision, prompting or assistance to be able to manage medication or monitor a health condition.

They need supervision, prompting or assistance to be able to manage medical or related appointments, or homeopathic interventions, or privately funded services, or therapy.

For therapies or medical or related interventions/appointments to be considered even when they are privately funded.

If medical or related appointments, or homeopathic interventions, or privately funded services, or therapy is required to manage a health condition for this to be considered whether the therapy/intervention occurs inside or outside the home.

If the person is on a waiting list for a diagnosis or a medical intervention or therapy, for this to be acknowledged.

Maintaining personal hygiene

Can wash and bathe and launder clothes and bedding and manage personal or intimate hygiene without any help or assistance.

The person needs to use an aid or appliance or may need supervision or assistance to be able to wash or bathe or launder clothes and bedding and manage other personal hygiene or intimate hygiene tasks (such as changing a tampon or sanitary towel). They need assistance, or the use of an aid to be able to get in or out of a bath or shower or to use a washing machine.

The person washes themselves:

• infrequently (resulting in poor hygiene and risk of harm) or
• excessively.

As a result of a disability or health condition the person needs to be motivated or assisted to wash or bathe or launder their clothes and bedding.

If they don’t have access to a washing machine and their mobility is poor, clothes and bedding may not be properly clean.

If they cannot buy cleaning products, or cognitively understand how to operate a washing machine, their clothes and bedding may not be properly clean.

As a result of a cognitive impairment or mental health problem, they may not manage their personal hygiene well

Managing toilet needs

The person needs to use an aid or appliance or needs supervision or assistance to be able to manage toilet needs or incontinence and/or to clean up after accidents.

Is the person able to access and use the toilet and manage their own toilet needs when outside of the home?

Is their ability to leave the home impeded by their incontinence needs?

If the toilet is no longer accessible due to mobility problems or if the person takes too long to get to the toilet, they may not be managing their toilet needs.

If they are unable to maintain their night-time continence, they may not be managing their toilet needs in a way that promotes their dignity.

Dressing and undressing and being appropriately clothed

The person can get dressed and undressed without any help or assistance.

They need to use an aid or appliance to get dressed or undressed.

Is the person able to dress themselves and be appropriately dressed, for example, in relation to the weather or the activities they are undertaking, which could include work/volunteering?

If they cannot put on or fasten their clothes, they are unlikely to be appropriately dressed. The person may be able to dress themselves in casual clothes unaided but may not be able to dress themselves in more formal clothes e.g. put on a tie, zip up a dress or clean their shoes, and so would not be appropriately dressed for their circumstances.

They need either:

• prompting to be able to dress appropriately, undress or determine appropriate circumstances for remaining clothed; or
• prompting or assistance to be able to shop for and select appropriate clothing or
• to be motivated to get dressed and wash and change clothes regularly.

Due to psychological constraints the person finds the act of dressing and undressing distressing and anxiety inducing.

Because of a disability or health condition they regularly and excessively change their clothes.

If they cannot acquire new clothes when needed, they may not be appropriately dressed e.g. for the change in seasons. This would include where a person needs support to shop for and choose new clothes and shoes.

If they are severely visually impaired, they may be able to dress themselves but not know if clothes are appropriate or clean.

Able to make use of their home safely

Is the person able to move around the home safely, including climbing steps, using kitchen facilities and accessing the bathroom/toilet?

If they cannot reach certain rooms, they may not be using the home safely or may be unreasonably confined e.g. having to spend all day in bed.

If they cannot get in or out of the front door (e.g. because they cannot manage the steps), they are unlikely to be using the home safely or have proper access to it.

Can the person use home appliances properly and safely (e.g. cooker, heater)?

Can they maintain a safe home environment without any assistance?

Maintaining a habitable home environment

Is the person’s home sufficiently clean and maintained to be safe, including having essential amenities?

Do they require support to sustain the home or maintain amenities such as water, electricity and gas or pay their rent or mortgage?

They cannot clean their kitchen or bathroom without support or assistance.

The impact of hoarding excessively, seriously impacts on the person’s safety and wellbeing.

It may not be a habitable home environment if the home is damp or in very poor repair.

Communicating

If the adult is unable to communicate easily and regularly, they may not have, or be able to use, a phone or computer, they may be unable to leave their home safely, they may be unable to communicate successfully or interact with others – this may prevent them from maintaining or developing relationships and lead to social isolation.

They cannot express or understand verbal information at all even with communication support.

The person cannot read or understand signs, symbols or words or is registered blind or has a severe visual impairment.

They need to use an aid or appliance (other than spectacles or contact lenses) to be able to read or understand either basic or complex written information or to be able to speak or hear.

They need communication support to be able to express or understand basic or complex verbal information and act on it.

Because of difficulty with communication the person has problems managing medication.

They may find communicating in certain situations or environments distressing and/or anxiety raising.

The person cannot safely and confidently access and understand how to use modern technology to engage in daily activities such as paying bills, shopping, communicating with professionals and friends and family etc.

Engaging and socialising with other people

The person can engage and socialise with other people without any help or assistance.

They need prompting, support or supervision to be able to engage with other people in a contextual and appropriate manner.

They cannot engage with other people due to such engagement causing either

• psychological distress to the individual; or
• the individual to exhibit behaviour which would result in a substantial risk of harm to the individual or another person.

Due to anxiety or a cognitive impairment, the person finds engaging with people difficult.

The person is lonely or socially isolated and may struggle to establish and maintain relationships with family and friends.

The person is at harm if engaging with and socialising with other people online.

Managing a budget, undertaking financial transactions and managing a bank account

Does the person have a formally appointed financial guardian?

The person cannot make any budgeting decisions at all and cannot manage a bank account or be responsible for any financial transactions such as paying bills.

Can they use modern technology such as banking apps to make payments and manage financial transactions?

Are they vulnerable to other people misusing their money?

Can they manage complex budgeting decisions and financial transactions without any help or assistance.

They need prompting or assistance to be able to:

• make simple budgeting decisions
• manage a bank account
• understand financial transactions such as paying bills
• use modern technology safely – such as banking apps.

Mobility

Planning and going on a journey

Can the person get around in the community safely and are they able to use facilities such as public transport, shops and recreational facilities? (This includes the need for support when attending health care appointments and informal appointments e.g. being able to go to the library or to meet a friend in a cafe or pub.)

Can they plan and follow the route of an everyday or more complex journey unaided?

The person needs prompting or support to be able to leave the home and undertake any journey to avoid psychological distress to the individual.

Cannot undertake any journey because it would cause significant psychological distress to the individual.

The person leaves the house infrequently because undertaking any journey is challenging physically or emotionally or because the person is clinically vulnerable.

The person leaves the house infrequently due to incontinence or bowel or bladder conditions and the anxiety associated with the availability of public toilets.

If leaving the home unaccompanied can regularly become disorientated or lost.

Cannot go on an everyday journey without another person, assistance dog or orientation aid.

Cannot confidently use public transport.

If the adult is unable to walk, or to use public transport unattended or to organise alternative transport (e.g. someone giving them a lift), or does not have money for a taxi, they may not be able to access services locally.

Where does the person live? For example, a rural area where public transport is limited or where the terrain is not conducive to safe movement. How close are amenities such as shops and GP surgery?

Does the person experience excessive pain when moving around and/or breathlessness and/or chronic fatigue.

Moving around

The person has

• a permanent and substantial disability which means they are unable to walk or virtually unable to walk, or
• has a temporary, but substantial disability, which means unable to walk or virtually unable to walk which is likely to last for a period of at least 12 months, but less than 3 years or
• the effort of walking presents a danger to the individual’s life or would be likely to lead to a serious deterioration in their health.

The person’s ability to walk is affected to the extent that they are unable to access goods and services unless allowed to park close to shops, public buildings and other facilities.

The person requires help to negotiate the types of pavements or roads normally expected to find while walking outdoors.

The person experiences excessive pain when walking, or because of the effort of walking breathlessness is experienced.

Chronic fatigue is experienced because of walking.