PIP Q13 Going out

Gordon wrote: I'm afraid I think the DWP will take the view that it is the pain that is preventing her from following a route rather than anxiety and this cannot be considered for this activity.

I kept a diary with Mrs P for a month, and on 4 days out of 28 she walked 20-30 metres, which she does when it is unavoidable for example to get into the doctors surgery. She does not usually walk this distance because the impact on muscle pain means she cannot walk so far or do other things the following day. So she should score 12 points for this activity, however as we know they may decide otherwise. Therefore I am looking at whether the journeys activity also applies and can provide points. As it is likely they will accept that Mrs P cannot walk 50 metres, it is only 2 or more points that is in question of course.

So setting aside the question of pain (I have read the case law and the history of this now, so I have a better idea why there is such a problem with qualifying for this activity with a condition where pain is a major factor). I think this is a terrible piece of legislation and a good example of why legislating by regulation should not happen since the courts cannot effectively correct it.

Taking the criteria in sequence (b) she cannot undertake a journey without prompting due to the psychological distress resulting from cognitive disruption caused by the fatigue/brain fog/social stress) she would experience. (Before we left the city I went to a hospital because I injured my hand at work. We went by taxi but after treatment could return home by public transport, nonetheless she called my daughter to accompany us because she could not plan, follow or undertake unprompted, the journey home, and I was rather out of it due to the shock. At that time pain did not prevent her from undertaking the route, but her condition certainly disrupted her cognitive capacity. The brain fog associated with CSS autoimmune diseases is a component that cannot be fully separated from pain since they are often concurrent, but is an independent factor.) Mrs P also has some Aspergers traits and hearing problems which exacerbate her difficulty communicating and stress in public situations She also has trouble with numbers, timings and sequences which make bus timings very difficult.

(c) She cannot plan the route of journey because she cannot access or use a bus timetable. She be able to use a street map to identify a route to her destination given enough time to think about it. In the city she never used a timetable or a bus map because she found them incomprehensible (Aspergers trait) and learnt bus routes by taking buses in both directions until she understood where they went.

(d) She cannot follow the route of a journey because she will not know where to get off the bus and communicating with strangers about that will be impossible because she will have difficulty making herself understood and understanding what is being said to her (combination of pain, fatigue, aspergers traits and cognitive disruption aka brain fog. The same problem arises as to how she would handle any unexpected event. Her Aspergers traits cause problems with following sequences.

(e) She cannot undertake the journey because the fatigue / brain fog / social stress will result in overwhelming psychological distress.

In practice she simply would not undertake a journey in this way she would get someone to accompany her, even if she took a taxi, in case the because too confused/stressed to communicate. Logically she should qualify for f as she is in practice unable to take a journey. I can see that all the charities that deal with pain related disorders are not happy about this.

Anyway my question is which of the points above are worth making and which are not worth including. Bear in mind Mrs P has never had an Aspergers diagnosis as when we were children it wasnt a recognised condition. With todays insight into Aspergers we know why she has difficulty interpreting body language, social cues, why she causes offence easily, and has problems with understanding communication.

Does safety have relevance? My daughter and I agree that we would not allow Mrs P to attempt a journey unaccompanied as her pain/fatigue/brain fog/cognitive disruption from those and her social anxiety/communication problems would collectively cause her to be unable to anticipate, evaluate and respond to risks as they occurred. She would be unsafe around traffic, crossing roads, trip hazards, and understanding safety signage and announcements.

The department said this in their answer to the select committee on which mental health issues might qualify for enhanced mobility. "A person who has chronic fatigue syndrome (CFS) and experiences symptoms including significant fatigue following physical exertion, muscular and joint pain and balance problems, together with psychological difficulties which manifest as depression and panic attacks, could qualify for the enhanced rate under mobility activity 2, or by scoring points on a combination of mobility activity 1 (4 points under descriptor b, for requiring prompting to avoid psychological distress when undertaking any journey) and mobility activity 2 (8 points under descriptor c, for being able to stand and then move unaided more than 20m but no more than 50m). As explained above, Chronic Fatigue Symptom (CFS), also known as myalgic encephalomyelitis (ME), has complex causes which are still not well understood, but which may involve both physical and psychological factors."

Fibromayalgia and CFS are closely related conditions which both have physical and psychological impacts. Since the HAs/DMs have already been primed by the department to acknowledge this combination of points for one of this "group" of diseases, it seems the safest option to target b and e. I find that very distasteful as in my opinion it overlooks the fact that cognitive impairment should make any of c d and f apply. But hey, lets opt for the path of least resistance.....

So of course DWP gave no points for this question. (Mrs P got a 5 year award of 10 points for 20-50 metres walking) We will do MR and appeal as her diary shows she only walked 20 metres on 4 days out of 28, and also as she goes back to bed at 1pm every day and doesnt get up again till the next day she cannot be said to be able to walk reliably. But we will also argue the journeys point both in case the 20m arguments fail and also as its part of the larger question of whether FM has cognitive and psychological impacts, and we also want to challenge the fact that she has received no points for cooking, communicating, reading, social contact, and finance. I have to help her with all those things, and some she avoids completely.

So they have argued as follows:
"mental state examination showed adequate memory, concentration and cognition. At the assessment you were observed to convey and understand information, you responded appropriately and without prompting. You engaged well with the assessor with adequate eye contact and rapport, you did not appear withdrawn or anxious." The assessment report also states "as she is not being treated for a mental health condition, and does not receive any specialist input for her mental health, and as the MSE showed she was not withdrawn, anxious, tense, sweating or trembling...... she can manage this activity".

Do we just need to focus on the fact that Mrs P DOES NOT go out on journeys even though she wants to, and that this is due to the psychological impacts of fibromyalgia which is an illness with physical and psychological components ( and include quote from DWP accepting this argument about chronic fatigue syndrome)? Any thoughts?

Have copy of assessment report and will put in MR request this week.