Pip review award ended despite no changes

Please can I get some help in writing a MR for my friend who has been refused pip on review.

My friend has long term depression and anxiety and suffers from bowel incontinence. Has been previously getting pip standard rate care mainly for need prompting for cooking, dressing, washing, mixing with other people. This is due to lacking motivation due to low mood due to ongoing long term depression and incontinence. (Has only retained 2 points for incontinence activity).
The reasons for refusal on pa4 seem to be copy and paste for each descriptor Hoc showing no specialist input no changes at last gp review moderate dose antidepressant no changes 5 years suggests stability and MSE showing unremarkable therefor on bop suggests should be able to perform ….
Although reports needing prompting this is inconsistent with the hoc showing no mental health input and then the above repeated again.

My friend had prepared for this phone assessment and had lists of medication and conditions start dates infront of her. The nurse assessor says in the report interaction normal adequate rapport speech normal fully alert answered all questions fully engaged well without input had adequate general memory and concentration. However, a few time my friend could not remember answers and most questions were simple and the nurse probed her further . Her partner was also present and the nurse could not see symptoms of distress. Despite this the nurse has used the 1 hour telephone assessment to carry out a MSE that implies her condition has no impact on the activities. Can it be argued the symptoms were not visible on a phone call? And do we say this in the MR?

My friend has previously had specialist MH input on a couple of occasions but the sessions ended due to being time limited and didn’t really help in the long term as the physical symptoms are ongoing for which she is getting specialist input. Can it be said in MR this as a reason why the depressive symptoms are ongoing and it is difficult for them to be managed due to ongoing physical symptoms. Can we say the nurse failed to recognise it’s not about diagnosis and treatment but about how it affects you in regards to no specialist MH input and also SI didn’t help on previous occasions?

the nurse says, showing moderate dose antidepressants With no changes suggest stability.The nurse was told the tablets help with generalised anxiety and cause sleepiness. So do we need to say this as a point in the MR? And that it is not a standard dose? Do we need to say lack of dose change is not proof of recovery?

Do we need to say in MR the nurse has not shown where her MH has improved ?? And made a decision on balance of probability ??

Additional to the above being copied and pasted for each activity on the washing and bathing the nurse says, “although she reports needing prompting this is inconsistent with the FH showing adequate motivation to wash face every morning”Surely this is illogical as washing hands or face in the morning after a toilet visit is not the same as washing and bathing. Should we say in MR that there is lack of motivation for bathing as it required washing the full body and takes longer that just washing the face ? How else can this be addressed?

Also for dressing and undressing aswell as the copy and paste nurse says “the evidence in the FH shows adequate motivation to change after been incontinent, although not majority of the days this is inconsistent with HoC showing no specialist MH input no changes at gp review no evidence of referrals ……..
Despite symptoms expressed, medication showing moderate dose anti drepressnt with no changes 5 years suggest stability and MsE showing unremarkable therefore BOp suggests she should be able to reliably dress or undress independently”

My friend said she changes her pads and lower body cloths after incontinence. Again do we need to argue the nurse was wrong in implying motivation to change after an Episode of incontinence is the same as motivation to get dressed generally daily. After accidents she is in soiled clothing so needs to change immediately to put her out of discomfort and odor and cause skin irritation.

Do we also say in MR that the nurse failed to apply repeatedly on dressing because incontinence is not on majority of days then motivation to dress is not on majority of days or do we just focus on the nurse was wrong on implying motivation to dress. ?

Do we need to say in MR friend is getting specialist input for physical symptoms? Has been ignored. And that incontinence has ongoing affect on MH.

What does the nurse mean when she says no changes suggest stability ? My friend has long term
Conditions symptoms are low mood and lacks motivation and needs prompting. The incontinence problems lead to social withdrawal and impact confidence in social situations embarrassment shame and loss of dignity leads to continued anxiety and depression leading to lack of motivation to engage in daily activities. She would need prompting otherwise would not engage with people, again the same copy and paste has been used to say she can do this activity on the bop.
So in MR do we need to repeat everything for this activity as for the other 3.?

Aslo there was another activity which was applied for but not awarded ( and not awarded previously either) and the nurse gave one of the reasons as “previous report showing independence.”
Can it be argued in MR that if the nurse is refusing points based on previous report not been awarded then why not give an award for the other 4 activities where an award was made previously?

And lastly, on mobility needing support on unfamiliar journeys which was not awarded now and neither awarded previously ( so don’t want to appeal this) but want to make a point that the reason the nurse gives for refusal of award here “the evidence in FH shows symptoms not OPD in nature, restrictions due to physical health and lacking motivation rather than OPD. And then futher on “although some MH symptoms have been reported this is in relation to mood changes rather than anxiety and there is no indication that the mood changes manifest OPD.”
Can we use this as evidence in MR for the other activities to show MH symptoms and lack of motivation do exist because here the nurse confirms them; whereas in previous descriptions she hasn't acknowledged lack of motivation or mood changes symptoms at all?

Also as I have only received pA4 and have less time to submit MR can I ask for a 2 week extension or is it automatic if you request pa4?

Many thanks for any help.

Thanks for that.
Can we say the assessor was wrong in implying motivation for washing the face as sufficient motivation for washing and bathing and also changing after incontinence as sufficient motivation to get dressed and undressed.

I'm so angry reading your post ,Sounds like a similar situation to myself,my last pip interrogation was 90mins of sheer hell from a very junior nurse, you can hear my distress, heavy breathing quite clearly on the recording she too said I wasn't stressed nor breathless,oh really??? I swear they say the opposite to what they hear or on a face to face see. I've been through the lies so many times but if we did that we'd be done for fraud,anyway I collapsed after my last pip assessment onto my bedroom floor,I was paranoid for almost 15mths after. They have made my MH plummet. Four yrs in,due another assessment soon and every day is utter fear. They need to start playing fair with us, the lies on all my assessments were disgusting. Anyway the upshot of it all is i got my pip reinstated at MR stage.This time I'm going to not leave a single thing out to support my claim. I have 14 conditions most decades or lifelong, the low dose Antidepressants is a crock, not everyone can tolerate high doses, I was on Prozac year's ago, and multiple others after some did nothing others barely. We are not all built the same. They need to learn that. Best of luck. Do not give up.