PIP MR

Hi im doing my uncles MR thing, but ive never done anything like this before, have you? and if you have could read and see if its ok, is it enough?

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Pip appeal MR request

To whoever it may concern

I’m writing to you in regards to the assessment and report of {moderator - removed full name} held on the ======. And am requesting the decision for scoring 0 on everything to be reconsidered or denied on the basis of the report’s integrity, contradictions and overall inaccuracies of cains conditions and how they impact him living a normal healthy life, furthermore the assessment results on the report is not consistent with the evidence and answer cain gave in this report.

suicidal depressed, anxious and paranoid he was unable to care for his disabled mum anymore or care for his dogs so he’s stopped doing this and had to give away his pets due to not being able to walk and feed them as they’d run into his legs which would the trigger cramp and more problematic mobility issues all throughout the day, only fuelling his sense of depression and discomfort leading to not influencing any of his motivation. However, If I could just take you into his daily life as it may help give you more information into the daily struggles that inevitably effects his chances for A happy fulfilling life.

Cain has an unstable sleeping pattern due to poor controlled mental health, pain in his legs from cramp and muscle spasms and on some night’s anxiety and paranoia, while on the rare occasion he suffers from them all at once, having just one of these factors is enough to prevent him from sleeping thus contributing to the domino effects of declination the following day.

unable to use a bath or a shower due to fear of falling or because the pain is just too unbearable and fatigue from no sleep so avoids the need all together, therefore I strongly encourage him to do so, and help him stand, walk, and sit, and change. While I have helped him before get in and out of the bath, he is able wash himself once in it, or if I’m unable to convince him to bath, I can convince him to use wet wipes, I will prompt him to brush his teeth, and use mouthwash because he suffers with halitosis due to what I believe to be dehydration.

Cain will find the experience of waiting rooms/busses/trains to much psychological stress where hell get panic attacks, rapid heart rate, dizziness and by the time he’s ready for his appointment no information goes in for him to retain the information and he’s unable to fully express why he’s there and will be vague with GPs about his conditions to quicken the experience so he can leave distressed and upset and he’s mentioned a feeling of defeat. he’s had a threat of eviction before for not allowing inspectors into his home due to poor managing of mental health, this is daily for him and needs constant prompting and reassurances, He is no longer able to take public transport for example busses or trains even though I’d be with him he will get really distressed and is unable to understand a route or plan a route, but I’m able to get him into a taxi, when he’s like this he’s sweating cant communicate and defiantly cant engage properly.

He suffers constipation a lot through poor diet however since I’ve been cooking for him and encouraging nutrient rich food this is getting better, He is able to feed himself and drink, when seated. While cain can sometimes manage his own toilet needs there have been occasions where he hasn’t done this, and he will often hold it for fear of triggering the pain, or is already in pain or he’s so tired he will wet himself, or unable to make it in time he however doesn’t use pads.

Cain is unable to make financial and budgeting decisions and his bills are now managed by myself as he is unable to manage these, furthermore I had to get a DRO order for him because he was unable to manage applying for himself. Dro was successful. he doesn’t go out shopping or buy things anymore through lack of concentration due to being in a social setting and cramps and dizziness and feeling sick, so out right avoids it all together as he has been sick before.

unable to go to the doctors alone. which has extensively exacerbated other conditions, mobility, social isolation, paranoia, hypertension, and hypoglycaemia. anxiety and depression to which I have no don’t in my mind is a dangerous combination of leading to suicide. . is having problems with his legs, 2 bilateral lumps on lower legs when he’s trying to walk these lumps on both legs will swell up and he is unable to put his foot to the floor to take another step. Having witnessed this myself I have seen the swelling and the kind of pain he is in. He has described it like his legs feel like they don’t belong to him and he’s using someone else’s feet. He struggles to concentrate and is very uninterested in anything to do with hobbies and will sit for hours in his own thoughts. All of are consistent with poor mental and physical health. To summarise

To summarise

• using his stick to walk
• uses his pill box
• ill sort his medication for him
• Encouraging him to take medication
• railings, hand rails for toilet
• foot stools to keep his legs elevated as this reduces the swelling and doesn’t make feet worse
• stool in the kitchen
• trying to get his appointments online
• Making him an appointment
• Prompting him to go to the appointment
• Helping him get ready to the appointment
• Convincing him to go to the appointment
• Assisting him getting to the appointment by ordering him a taxi, reassuring him the whole way there
• And reassuring him in the waiting room
• Collecting and ordering his medication
• Ill encourage him to get in the bath,
• If yes, I’ll help him get into the bath, he uses a chair to sit on or lie down to undress
• Most of the time he won’t so I will encourage him to use wet wipes I then get him wet wipes, but he is able to use wet wipes himself sat down.
• Prompt him to ask if he needs help going to the toilet and if he needs to go, mostly after I’ve cooked for him and I help him this is every day
• I will budget for him calculating his bills and what he has left, setting up and amending direct debits and help him when he rarely wants to buy something
• Unable to walk and go out alone distress and shaking and vomiting

Contradictions and inaccuracies in the report

Observations

Cain remembers very little from the assessment however it sated here

• did not sound tired-when I give cain his sertraline and painkillers in the morning at around 9,am it only takes 30 to 45 minutes for the side effects, the assessment was conducted 11.58 and stopped 1.19
• took time to answer the questions-does this imply a strong degree of concentration or a lack off concentration, given that cain remembers very little of the assessment and the answers cain gave within the report are “I cant remember” are more consistent with cains impairments rather then not
• and states numerous timed answer. he can’t remember to the most basic of questions about his health

History

Cain was diagnosed with depression in 2012 and has suffered with it on going and full time for 13 years and has no care plan in place with his GP because of braving the outside world with anxiety which has fuelled other conditions therefor explain a lack of ability to manage and care for himself, also please take into account that the very fact cain hasn’t applied for this benefit himself or hasn’t in the past, even though he’s entitled to under the guidelines set out on gov.uk is another indication into cains mental state when thinking and planning his own wellbeing and quality of life, as it is non-existent.

Cain has two bilateral lumps on his leg that swell just above the ankle when he stands, when he tries to walk he has described it as so painful that he cannot put his foot to the floor

As showing on cains medical records he is a high risk of diabetes, this should be taken into account as to why he’s not on medication, or been fully diagnosed, due to not being able to manage his own health needs, not because the condition doesn’t exist. It goes to on state that cain is being booked in for a ECG this is correct however please note this appointment on happened because I was there with him and made the appointment and encouraged him to go and help him to get there.

Current medication and treatment

consistent with the long term effects of crippling mental illness clearly indicating a struggling That correspond to these sections in the report, anxiety, depression and paranoia

• Managing medication
• Engaging with people face to face
• Mobility
• Washing and dressing

Social and occupational history

The assessor has stated that cain has no adaptations or aids in his home, this is an inaccurate statement, as cain uses hand railings stools, banisters and elevated foot stool and a stick to help him balance preventing him from falling over, this is an aid, a hand rail was put in for him recently, this is an adaptation as stated on your own guidelines.

While I understand that DWP outsource this process I find it extremely worrying as to why the assessor didn’t stop the assessment and reschedule it at a later stage for when cain was more coherent, as he slurs his words and cannot engage coherently when under the influence of his combinations of medication, therefor wouldn’t be able to express fully his limitations are and how they affect him. This isn’t stated on the report. The assessor has failed to put that he had to contact cains GP from going over they’ve recommended dose (please see medical history), which is another worrying factor to consider.

In the report it states cain can handle medication unaided however the report and gp records clearly show that the assessor states he has a duty of care and needed to contact cains gp informing them that he’s taken over the recommended dose and that he is suicidal thoughts every day but has no immediate plans to end his life as he couldn’t do that to Oliver (myself) But then has marked cain in the assessment as “Either –

1. does not receive medication or therapy or need to monitor a health condition; or
2. can manage medication or therapy or monitor a health condition unaided. 0 points.

“last worked years ago”, and “can’t remember”, “can’t remember” what dose he was given to him 2 hours before the assessment.

Having to stop working because a trolly crashed into his leg, all of which are consistent with what cain is reporting

• memory problems
• physical problems

has not been properly considered within the supporting descriptors, Please see evidence medical declaration-part B

Mental state page 7 of 22

It isn’t necessarily what cain takes medication wise but rather the effects they have on him when they are combined in his system and his current metal state. These factors combined result in cain not being able to care and look after himself

All throughout this report the assessor has claimed on multiple occasions that cain said he can’t remember to things that cain should remember and while cain remembers very little from the assessment due to taking medication, it is a strong indication of cognitive impairment therefore corresponds to difficulties with being motivated to

• washing and bathing
• mixing with other people
• managing medication
• and budgeting

I ensure cain takes his sertraline every day as he is so reluctant and paranoid to be left to take it on his own, as he doesn’t trust the sertraline and becomes paranoid to what its doing to him and when he’s gone a few days without it, he is extremely paranoid, dizzy, manic, underwhelmed/over whelmed sometimes leading to aggressive confrontations, however I’m always able to reason with him in the end but after a strong degree of prompting and encouragement that I believe goes far beyond anything reasonably justifying scoring him 0 on as it corresponds to assessment descriptors written in the report. I now have to manage how much pain killers he has to take, he is unable to stand and move for more than few seconds without being in pain (even using his aid) Please see evidence medical declaration-part B

Preparing food

cain can remember very little from the assessment but was asked if he could hold a saucepan full of water, due to cains inability to walk, he is unable to get up walk to the kitchen, collect a saucepan, walk to the sink, stand, wait for it to fill up, turn while using a crutch from pair of crutches to help balance and walk to the cooker and use it, stand or sit, wait for it to boil and then cook, walk over to the counter with one hand on a walking stick for support whilst holding boiling water, standing and prepare the meal, walk back to the sink to put everything away etc, walk back to his meal and pick it up with one hand, walk back to his chair, then eat it. he needs prompting to drink water as he gets severe halitosis due to what I believe to be dehydration and claiming he ignores being thirsty due to the hassle of having to get up and go get a drink. This is another factor that could influence your decision. Recommendation and evidence used states that there has not been a recent change to his antidepressants, however there has been a change to the medication he takes alongside his antidepressants, NHS England state side effects including but not limited to

• drowsiness
• dizziness
• central nervous problems, impaired thinking, difficulty concentrating and reduced coordination
• potential for decreased pain relief causing someone to may take more than the recommend dose

all consistent with cains symptoms and are disregarded in the report.

Other descriptor report states whilst aids have been considered however ruled out because of know treatment to his legs, but says he’s due to have his legs scanned, this is another inaccuracy that could influence your decision. While prompting has been considered, he is under the care of his GP, again cain will not go to the doctor alone. It also states whilst loss of conscious has been considered the risk of harm is considered to be low, it states in the report that this happened in the kitchen where cain lost consciousness in the kitchen, it doesn’t mention why cain was in the kitchen, what was he doing, was he cooking anything? The vagueness and contradiction would likely influence your decision and dismiss this. Under the care of his gp and shown not to be withdrawn- I make cains appointments for him and help him go and get back.

MSE or mental state examination- showing adequate cognition- this isn’t consistent with cains conditions and side effects and medical history and evidence as the long-term effects of depression and anxiety contribute more to a downward spiral then seeking out help to combat it, plus you combine this with the side effects of medication ad this would be impossible for him to do. This isn’t properly considered withing the report, therefore influencing your decision. Please see evidence medical declaration-part B

Activity 9 engaging with others face to face

Please see evidence medical declaration-part B

Contradicting the assessors claim and is supporting evidence that cain has so such bad mental health that he is unable to engage with other people and get employed and manage health

MEDICAL DEC PROOF"

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Activity 6 dressing and undressing- cain will miss appointment due to anxiety of going outside, the last blood test cain had wouldn’t give a clear indication as to how the condition is now, this hasn’t been taken into account, and with current reports on the updated medical history are consistent with what cain is going through.

Activity 11 planning and following journeys

Cain is unable to go anywhere alone due to paranoia of other people and anxiety and the fear of having a hypo all of which are consistent to his medical records evidence and medical declaration-part B another inaccuracy that could influence your decision

Other descriptor supported-medical history clearly shows cain reporting problems with his legs and is currently awaiting an appointment for them to be scanned another inaccuracy that could influence your decision

Scoring that we are challenging

• Can prepare and cook a simple meal unaided.0 points.
• Can take nutrition unaided.0 points.
• Either –does not receive medication or therapy or need to monitor a health condition; or can manage medication or therapy or monitor a health condition unaided. 0 points
• Can wash and bathe unaided.0 points.
• Can manage toilet needs or incontinence unaided.0 points.
• Can dress and undress unaided.0 points.
• Can express and understand verbal information unaided.0 points.
• Can read and understand basic and complex written information either unaided or using spectacles or contact lenses.0 points.
• Can engage with other people unaided.0 points
• Can manage complex budgeting decisions unaided.0 points.
• Can plan and follow the route of a journey unaided.0 points.
• Can stand and then move more than 200 metres, either aided or unaided.0 points.

Scoring that we are asking to be reconsidered

• Needs to use an aid or appliance to be able to either prepare or cook a simple meal. 2 points. Or cannot cook a simple meal using a conventional cooker but is able to do so using a microwave2 points or Needs prompting to be able to either prepare or cook a simple meal. 2 points.
• Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week. 2 points.
• Needs to use an aid or appliance to be able to wash or bathe. 2 points
• Needs to use an aid or appliance to be able to manage toilet needs or incontinence. 2 points orNeeds supervision or prompting to be able to manage toilet needs. 2 points.
• Needs either -
  • prompting to be able to dress, undress or determine appropriate circumstances for remaining clothed; or prompting or assistance to be able to select appropriate clothing. 2 points.
• Needs social support to be able to engage with other people. 4 points. Or cannot engage with other people due to such engagement causing either –overwhelming psychological distress to the claimant; or the claimant to exhibit behaviour which would result in a substantial risk of harm to the claimant or another person. 8 points.
• Needs prompting or assistance to be able to make simple budgeting decisions. 4points. or Needs prompting or assistance to be able to make complex budgeting decisions. 2 points
• Needs prompting to be able to undertake any journey to avoid overwhelming psychological distress to the claimant. 4 points.
• Can stand and then move more than 1 metre but no more than 20 metres, either aided or unaided. 12 points.

From experiencing looking after cain and from reading the report we can confidently argue that cain hasn’t been assessed properly and request you to reconsider his score and your decision that may have been influenced by Serco’s report. While the phone call wasn’t recorded and cain not being able to remember what was asked and what was said, there is a lot of contradictions and I have to ask you take this into consideration. I understand that the assessor just has a job to do and granted the assessor probably didn’t have much to go on, however the number of contradictions and inaccuracies with the report should indicate perfectly reasonable reasons to request a mandatory reconsideration on the grounds of inaccuracies and contradictions affecting the integrity and professionalism of this process and benefit, potentially denying cain of this entitlement and could potentially breach your own terms and conditions and government legislation currently defined under the equality act of 2010.

Many thanks for considering this and thank you for your time.

Family history medical records and current medicine/ patient summary

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summary of some daily thoughts

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References

https://www.citizensadvice.org.uk/work/discrimination-at-work/dealing-with-discrimination-at-work/checking-if-its-discrimination/check-if-youre-disabled-under-the-equality-act-work/

https://www.gov.uk/

https://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpgaen_20100015_en.pdf

https://www.3chequers.co.uk/

Conditions that aren't impairments

Some conditions aren’t disabilities under the Equality Act 2010. They include:

• hayfever
• voyeurism or exhibitionism
• a tendency to set fire to things
• a tendency to steal things
• a tendency to physically or sexually abuse others

Example

Examples of mental health conditions that can be considered disabilities under UK law (Equality Act 2010) include conditions like depression, bipolar disorder, schizophrenia, autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD). These conditions can affect a person's ability to perform daily activities and may lead to discrimination in various settings, including employment

Tom has type 1 diabetes. He has to monitor his glucose levels and give himself insulin injections several times a day. If he controls his glucose levels, he doesn’t usually have any symptoms. 

He's disabled because without the correct dose of insulin, the diabetes would have a substantial long-term adverse effect on his normal day-to-day activities. 

Example

Jodi’s been struggling with everyday tasks since her partner left her a year ago. She can’t plan activities like shopping or following a recipe to cook a meal. She wouldn’t get up and dressed in the mornings if her daughter didn’t encourage her. She’s stopped going out because she doesn’t want to talk to people.

Jodi has a mental impairment. It doesn’t matter if she’s hasn't been diagnosed with a medical condition like depression - although that can help to prove she has an impairment. But she'll need to show the impairment is long-term and has a substantial adverse effect on her ability to carry out day-to-day activities.