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MEDICAL SERVICES 
 
 
 
PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS
 
 
 
 
 
Training and Development Unit 
 
 
Guidance for Examining Health Care 
Professionals 
 
MED/S2/EHCP~0010 
 
 
Version: 9 Final 
14 September 2009 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Medical Services 
 
 
Foreword  
 
This guidance has been produced as part of the training programme for Health Care 
Professionals seeking approval by the Department for Work and Pensions Chief Medical 
Adviser to carry out assessments in Disability Living Allowance and Attendance Allowance. 
All Health Care Professionals undertaking medical assessments must be registered medical 
or nursing practitioners who in addition, have undergone training in disability assessment 
medicine and specific training in Disability Living Allowance and Attendance Allowance. The 
training includes theory training in a classroom setting, supervised practical training, and a 
demonstration of understanding as assessed by quality audit. 
This guidance must be read with the understanding that, as experienced medical or nursing 
practitioners, the Health Care Professionals will have detailed knowledge of the principles 
and practice of relevant diagnostic techniques and therefore such information is not 
contained in this guidance. 
In addition, the guidance is not a stand-alone document, and forms only a part of the training 
and written documentation that a Health Care Professional receives. As disability 
assessment is a practical occupation, much of the guidance also involves verbal information 
and coaching. 
Thus, although the guidance may be of interest to non-medical readers, it must be 
remembered that some of the information may not be readily understood without background 
medical knowledge and an awareness of the other training given to Health Care 
Professionals. 
 
Office of the Chief Medical Adviser 
September 2009 
 
 
Guidance for Examining Health Care Professionals 
9 Final 
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Document control 
Superseded documents  
Guidance for Examining Health Care Professionals v8 
Version history 
Version Date 
Comments 
9 Final 
14 September 2009  Signed off by Medical Services Contract Management 
Team  
9b draft 
27 August 2009  
Comments from Customer incorporated 
9a draft 
28 July 2009  
Updated by Dr P Ellis following Schedule 28 Review 
8 Final 
16 May 2008  
Signed off by Medical Services Contract Management 
Team 
Changes since last version 
Customer comments about DDA, Judges of the Upper Tribunal, and other 
clarification incorporated. 
 
Outstanding issues and omissions 
 
Issue control 
Author: 
Dr Peter Ellis 
Owner and approver: 
The Medical Director 
Signature: 
Date: 
Distribution: 
Guidance for Examining Health Care Professionals 
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Contents 
Section Page 
1. 
Abbreviations 9 
2. 
About this Guide 
10 
3. 
The Department for Work and Pensions (DWP) 
11 
3.1 
Introduction 11 
3.2 
Structure of the DWP 
11 
4. 
Atos Healthcare 
13 
4.1 
Introduction 13 
4.2 
Role of Atos Healthcare 
13 
4.3 
Conditions of work 
14 
4.4 
Professional Standards 
14 
5. 
The role of the Examining Health Care Professional 
15 
5.1 
Introduction 15 
5.2 
Training and approval 
15 
5.3 
Ongoing training 
16 
5.4 
Auditing of reports 
17 
6. 
Main features of Disability Living Allowance & Attendance 
Allowance 18 
6.1 
Disability Living Allowance (DLA) 
18 
6.2 
Attendance Allowance (AA) 
18 
6.3 
Decision making 
18 
6.4 
Self reporting 
19 
6.5 
Disability criteria 
19 
6.6 
Personal care 
20 
6.7 
Three rates of the care component 
20 
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6.8 
Mobility problems 
20 
6.9 
Attendance Allowance 
22 
6.10 
Qualifying periods 
23 
6.11 
Terminal illness cases 
23 
6.12 
Children under the age of 16 
23 
7. 
Factors considered by the Decision Maker - care 
24 
7.1 
Severe disability 
24 
7.2 
Attention 24 
7.3 
Supervision/watching over 
25 
7.4 
The main meal test 
25 
7.5 
Are the needs reasonable? 
26 
7.6 
Age 26 
7.7 
Aids to help the disabled 
27 
7.8 
Day or night supervision/attention 
27 
7.9 
Children 27 
7.10 
Variable needs 
27 
8. 
Factors considered by the Decision Maker - mobility 
28 
8.1 
Unable or virtually unable to walk 
28 
8.2 
Exertion 28 
8.3 
Amputations 29 
8.4 
Walking aids 
29 
8.5 
Deafness and blindness 
29 
8.6 
Severe mental impairment 
30 
8.7 
Guidance and supervision 
30 
8.8 
Intermittent problems 
31 
8.9 
Children 31 
8.10 
Benefits of getting out and about 
31 
9. 
Equal Opportunities and other legislation 
32 
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9.1 
Equal Opportunities Policy 
32 
9.2 
Race Relations Act 1976 
32 
9.3 
The Sex Discrimination Act 1975 
32 
9.4 
The Rehabilitation of Offenders Act 1974 
33 
9.5 
The Disability Discrimination Act 1995 
34 
10. 
Administrative guidance for the EHCP 
37 
10.1 
Making appointments for domiciliary visits 
37 
10.2 
Telephone contact with claimants 
38 
10.3 
Identification of the claimant at the assessment 
39 
10.4 
Special need requirement 
40 
10.5 
EHCP reports completed by a third party 
41 
10.6 
Abortive visits (no report provided) 
42 
10.7 
Non aborted visit (report incomplete) 
44 
10.8 
The claimant refuses you entry 
44 
10.9 
Carrying out a requested DV where the Claimant is a Hospital In-
patient 44 
11. 
Recommended approach to Disability Assessment 
47 
11.1 
Comparison of role of Clinicians and Disability Analysts 
47 
11.2 
Disability analysis in DLA/AA 
48 
11.3 
Definitions of disability and impairment 
48 
12. 
Completion of reports 
49 
12.1 
Introduction 49 
12.2 
Recording information from the claimant 
50 
12.3 
Physical examination in EHCP assessments 
59 
12.4 
Mental state examination 
61 
12.5 
Your opinion 
61 
12.6 
The assessment of mobility 
62 
12.7 
The assessment of care needs 
64 
12.8 
Epilepsy Questionnaire 
66 
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12.9 
Functional prognosis 
66 
12.10 
Variability of conditions 
66 
12.11 
Unexpected findings (see Appendix E) 
69 
12.12 
Harmful, embarrassing and confidential information 
69 
12.13 
Personal descriptions in medical reports 
70 
12.14 
The assessment of Chronic Fatigue Syndrome (CFS) 
73 
13. 
Risk management for the EHCP 
75 
13.1 
Potentially aggressive situations 
75 
13.2 
Audio or video taping of examinations 
76 
13.3 
Taking of notes during an examination by the claimant or their 
companion 77 
14. 
Assessing quality of service 
79 
14.1 
Claimant satisfaction 
79 
14.2 
Integrated Quality Audit System (IQAS) 
79 
15. 
Complaints 82 
15.1 
Definition of a complaint 
82 
15.2 
Why are complaints important? 
82 
15.3 
The complaints procedure 
82 
15.4 
Customer Relations Team (CRT) 
84 
15.5 
Complaints and the EHCP 
84 
15.6 
Escalation of a complaint 
87 
15.7 
Independent Tier 
87 
15.8 
Serious Complaint Investigation Team (SCIT) 
88 
Appendix A - Atos Healthcare Professional Standards 
90 
Personal Conduct 
90 
Appendix B - Professional Standards - Disability Living Allowance and 
Attendance Allowance 

93 
Appendix C - Attributes for examinations in DLA/AA 
94 
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Definition and interpretation of generic attributes 
94 
Presentation and process attributes 
96 
Appendix D - Abortive Visits – Form AV1 
96 
Appendix E - Unexpected Findings – disclosure of clinical information by 
Health Care Professionals to claimants’ General Practitioners 

97 
Introduction 97 
1) GMC / NMC Guidance 
97 
2) Procedures for dealing with unexpected findings when the claimant provides 
written informed consent 
98 
3) Guidance for contacting the claimant’s doctor 
98 
4) Procedures for dealing with unexpected findings when the claimant refuses 
consent to release information 
99 
5) General procedural guidance 
100 
6) Customer Service Desk (CSD) 
101 
7) Unexpected findings arising during the course of file work 
101 
Appendix F - UE1 (Rev), POID 1 & UE 2 
103 
Acceptable Forms of Identification 
105 
Appendix G - Unexpected Findings Process Map 
107 
Appendix H - Taking of Notes during an Examination by Claimant or 
Companion 113
 
Appendix I - DLA in Children 
114 
Observation Form 
118 
 
 
 
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1. Abbreviations 
 
 AA 
Attendance Allowance 
 
CMA 
Chief Medical Adviser 
CMO 
Chief Medical Officer 
CMS 
Complaints Management System 
CRT 
Customer Relations Team 
DBC 
Disability Benefits Centre 
DCPU 
Disability Contact and Processing Unit 
PDCS 
Pensions, Disability and Carer Service 
DLA 
Disability Living Allowance 
DLAAB 
Disability Living Allowance Advisory Board 
DM Decision 
Maker 
DV Domiciliary 
Visit 
DWP  
Department for Work and Pensions 
EHCP 
Examining Health Care Professionals 
GMC 
General Medical Council 
GP General 
Practitioner 
MEA 
Medical Examination Assistant 
MM Medical 
Manager 
MSEC  
Atos Healthcare examination centre 
MEC 
Medical Examination Centre 
NINO 
National Insurance Number  
NMC 
Nursing and Midwifery Council 
VCC 
Virtual Contact Centre 
VPP 
Viable Practitioner Pool 
VPPC 
Viable Practitioner Pool Centre 
 
 
 
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2. About 
this 
Guide 
This guide is for use by Examining Health Care Professionals who carry out 
examinations on behalf of the Department for Works and Pensions for claims to 
Disability Living Allowance (DLA) and Attendance Allowance (AA).  It is intended 
to be used as pre-course reading for new EHCPs prior to attending a training 
course and to be used thereafter as a reference source.  It provides new material 
and recommendations for best practice that will be essential information for 
existing EHCPs. 
This Guide provides information on the following topics: 
 The Department for Work and Pensions. 
 Atos  Healthcare 
 Background and features of DLA and AA. 
 Decision Maker’s role. 
 EHCPs  role. 
 Report forms and how to complete them. 
 Good practice techniques for conducting disability assessments. 
 Risk management of problem situations. 
 Quality systems - customer satisfaction, complaint procedures and audit. 
 Procedures for dealing with unexpected clinical findings and with abortive visits. 
 
 
 
 
 
 
 
 
 
 
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3. 
The Department for Work and Pensions (DWP) 
3.1 Introduction 
Disability Living Allowance was introduced in 1992 and has its origins in the 
Social Security reforms instigated in 1984 by the Minister for Social Security.  The 
Office of Population Censuses and Surveys was commissioned to undertake a 
comprehensive survey of the extent of disability in Great Britain, which resulted in 
the publication of a White Paper "The Way Ahead - Benefits for Disabled People". 
One of the main proposals was the introduction of a new benefit (Disability Living 
Allowance - DLA) that would: 
1) 
Bring together Attendance Allowance and Mobility Allowance as one benefit for 
claimants whose disabilities began before the age of 65; and 
2) 
Offer financial assistance to less severely disabled people not covered by the 
old scheme. 
Attendance Allowance continues for people over 65. 
Initially the Benefits Agency was established as an Executive Agency of the 
Department of Social Security in 1991. Subsequently the Department for Work 
and Pensions was created in June 2001, its purpose being, “to promote 
opportunity and independence for all.”  
3.2 
Structure of the DWP 
The department’s services to customers are provided through (amongst others): 
 Jobcentre Plus – helps people of working age to find work and receive the 
benefits to which they are entitled 
 Disability and Carers Service  
3.2.1 Pensions,  Disability  and Carers Service (PDCS) 
The Disability and Carers Service is part of the Pension, Disability and Carers Service 
(PDCS), an executive agency of the Department for Work and Pensions. 
The Pension, Disability and Carers Service vision is “Working together to make 
lives better".
 
The benefits administered to people with disabilities and their carers by the PDCS 
are: 
 Disability Living Allowance (DLA) 
 Attendance  Allowance  (AA) 
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 Carers Allowance (CA) 
 Vaccine Damage Payment Scheme 
CA is paid to carers of people in receipt of DLA or AA. 
 
 
 
 
 
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4. Atos 
Healthcare 
4.1 Introduction 
The contract to provide Medical Services to the Benefits Agency (and 
subsequently the DWP) was awarded to Sema Group in 1998. Medical Services 
then became part of SchlumbergerSema and subsequently part of Atos Origin in 
2004 becoming Atos Healthcare in 2007.  
Atos Healthcare is an integrated medical and administrative division of Atos 
Origin with 12 main medical centres based in the main population centres in the 
UK. Atos Healthcare provides the medical expertise to DWP for the following 
main benefits  
 Incapacity Benefit (IB) 
 Industrial Injuries Disablement Benefit (IIDB) 
 Disability Living Allowance and Attendance Allowance (DLA and AA) 
 Vaccine  Damage. 
The Viable Practitioner Pool Centre (VPPC) is responsible for the initial aspects 
of recruitment, payment and contract management of Examining Health Care 
Professionals (EHCPs) on behalf of Atos Healthcare.  Atos Healthcare itself is 
responsible for training and ongoing support of EHCPs.  Atos Healthcare, and in 
turn the VPPC, keep accurate updated lists of practitioners, their availability and 
the range of work that they can perform. 
4.2 
Role of Atos Healthcare 
Atos Healthcare help the Decision-Making Authorities to reach fair and proper 
decisions on eligibility for benefit by providing them with: 
 Disability assessment advice 
 Interpretation of medical evidence. 
Atos Healthcare Examining Health Care Professionals have specialised expertise 
as Disability Analysts.  Examining Health Care Professionals assess a person’s 
restrictions and limitations caused by disability, and advise the Decision-Maker in 
accordance with the relevant legislation.  For DLA, this advice is formulated 
around the care and mobility needs likely to arise in the course of a person’s daily 
life. 
We are also committed to the delivery of the highest possible quality of service to 
claimants and to our customers.  This is reflected in Atos Healthcare’s 
Professional Standards and Service Level Agreements. 
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4.3 
Conditions of work 
Atos Healthcare Examination Centre (MSEC) allocates work when it becomes 
available.  Examinations may take place in the MEC or in the claimant’s home 
(DV).  
EHCPs are (mostly) self-employed and there can be no guarantee of case 
numbers.  For DVs, EHCPs are required to return the completed casework within 
the agreed number of working days (12) from the date of issue of the request. In 
the MEC, the cases are returned as they are completed in the session.  
The VPP is responsible for the payment of fees for the examination and report 
and expenses for mileage, postage, and telephone costs.  Queries on payment 
due should be made to the VPPC or allocations sections, according to local 
practice. 
For DVs, the allocations section in the MSEC sends cases to the EHCP nearest 
to the claimant when practicable, taking into consideration travelling costs and the 
availability of EHCPs. The allocations sections are also responsible for: 
 Processing fee and expense claims. 
 Monitoring clearance times and abortive visits, and 
 Resolving problems over case delay, visiting difficulties, and the completion of 
expenses claims. 
Any complaints about the standard of the EHCP service are referred by the 
PDCS or directly from the claimant to Atos Healthcare for investigation.  The 
complaints procedures are covered in more detail in section 15 of the guidance.  
4.4 Professional 
Standards 
There are clearly stated Claimant Service Standards common to all areas of work 
and additional standards for each benefit.  All the standards are periodically 
measured. 
The standards relevant to EHCP work are set out in Appendices A and B and 
EHCPs are expected to adhere to these when carrying out their work. 
 
 
 
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5. 
The role of the Examining Health Care 
Professional 

5.1 Introduction 
The role of the EHCP is to provide reports, which may be: 
 Required by the Decision Maker (DM) to determine entitlement to Disability 
Living Allowance or Attendance Allowance. 
 Requested by the claimant. 
 Required by the Tribunals Service to determine entitlement to DLA or AA. 
EHCPs may be asked to examine and provide a medical report on a DLA or AA 
claimant at any stage of the decision-making process.  The DM may decide this 
when: 
1.  The self-assessment statement has not been completed 
2.  Further evidence or clarification is required 
3.  A factual report is inconclusive or not obtainable   
 
GPs or hospital doctors usually provide factual reports. They usually contain 
mostly clinical information, which the EHCP may be required to interpret from a 
functional viewpoint.  
5.2 Training 
and 
approval 
Experienced full-time Registered Medical Practitioners train EHCPs.  This may be 
supplemented with additional input from DMs. 
Training is given on: 
 The ethos of the Department for Work and Pensions. 
 Equal opportunities policy and relevant legislation. 
 Atos Healthcare’s Professional Standards. 
 Customer  service. 
 Disability  awareness. 
 Benefit  awareness. 
 Decision making awareness. 
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 Examination technique and report completion. 
 Approval. 
 Quality systems and audit. 
 Interview  technique. 
 Fraud  awareness. 
 Risk management of problem situations. 
 Administrative  arrangements. 
 Complaints  procedures. 
5.2.1 Initial training 
This consists of five steps: 
1.  Trainer-led training day: Disability Analysis for New Entrants 
2.  Stage 1 training: A two-day, trainer-led course. All Candidates must attend. 
3.  Stage 2: Obtaining a pass mark in a Multiple Choice Questionnaire (MCQ) 
examination at the end of Stage 1 
4.  Stage 3 training: observation of a local trainer performing an EHCP 
assessment, followed by observation of the candidate by the trainer. 
5.  Stage 4 training: 100% targeted audit and feedback of cases until four ‘A’ 
grades have been achieved.  
Further cases may be selected at stage 4 at the Medical Manager’s discretion. 
Standard audit protocols are used. The feedback method is at the discretion of 
the mentor e.g. telephone, letter or in person. 
After completion of these cases, the candidates will have a formal review with 
their mentor. This interview will be structured according to certain advisory 
guidelines. On satisfactory completion of this process, the Medical Practitioner’s 
name is submitted to the CMA for approval. 
5.3 Ongoing 
training 
When procedural or legislative changes occur, updated information is circulated 
to EHCPs.  Atos Healthcare provides details of Continuing Medical Education and 
each EHCP has a Personal Training Plan. The details of update training and 
feedback are logged. 
 Where an EHCP is not meeting the required standards for reports, further 
training may be offered at the discretion of Atos Healthcare, but persistent failure 
to achieve the standards required will result in non-allocation of further work. 
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5.4 Auditing 
of 
reports 
EHCP reports will be subject to periodic monitoring by employed Atos Healthcare 
doctors.  DMs may also refer reports for monitoring if they contain weaknesses. 
EHCPs will be informed of the outcome of this monitoring.  If the standard of 
reports is unsatisfactory, and this includes illegible writing, a decision on remedial 
training will be made before any more work is offered.  More information on the 
quality systems will be provided later in the guide (section 14.2 and Appendix C). 
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6. 
Main features of Disability Living Allowance & 
Attendance Allowance 

6.1 
Disability Living Allowance (DLA) 
Disability Living Allowance is a non-contributory, non-means tested and tax-free 
benefit that is based on an assessment of care and mobility needs for people with 
disability. DLA is payable to those with qualifying needs where the claim is made 
before the age of 65. Where DLA entitlement is established before the 65th 
birthday, DLA can run on beyond the age of 65. The Decision Maker (DM) treats 
any claim for DLA as a claim for both care and mobility components: 
 Care - payable to those who need help with personal care or who have difficulty 
planning and preparing a main meal. 
 Mobility - payable to those with mobility problems due to a physical difficulty 
with walking, or with a need for guidance or supervision when walking in 
unfamiliar places out of doors due to physical or mental health problems. 
Personal care means attention to bodily functions or supervision/watching over to 
prevent substantial danger to themselves or others. 
A DLA claim consists of both components.  Care component entitlement can be 
considered from birth.  The higher rate mobility component cannot be awarded 
before the age of three years.  The lower rate mobility component cannot be 
awarded before the age of 5 years. 
There are lower, middle and higher rates to the care component. The mobility 
component is payable at lower and higher rates. 
6.2 
Attendance Allowance (AA) 
 
AA is payable to those whose needs arise after the age of 65 (or who claim after 
that date) and it relates to personal care only. AA does not have a Mobility 
component.  It has two care rates, lower and higher, which are equivalent to the 
middle and highest rates of DLA care component. 
6.3 Decision 
making 
The non-medical DM decides the rate of benefit to which the claimant is entitled, 
basing their judgements on the law.  The system also allows for: 
 A speedy reconsideration of a decision usually by a different DM 
 Appeals against the original and reconsideration decisions organised by the 
Tribunals Service  
 Appeals against the Tribunals Service decisions on a point of law to the Judges 
of the Upper Tribunal and then, with leave, to the Court of Appeal (matters of 
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fact cannot be the subject of appeal to Judges of the Upper Tribunal or to the 
Courts). 
A tribunal for DLA/AA consists of a: 
 Legal  chairperson 
 Medical member  
 Person experienced in dealing with the needs of people with disabilities. 
All members have an equal say in the decision.  The chair can give a legal 
interpretation of the evidence and the doctor can use expertise to interpret the 
medical evidence for the other members. The medical member of the tribunal 
does not conduct a formal physical examination.  However, tribunal members can 
interpret observations made of the appellant during the proceedings, if he/she is 
present. 
Appeals on non-disability issues are directed to the Tribunals Service, which 
determines the appropriate constitution of tribunal to review the situation. 
6.4 Self 
reporting 
Claims for DLA and AA use evidence provided by the claimant indicating how, in 
their opinion, the illness or disability restricts essential daily activities.  
This gives claimants an opportunity to make a full written statement about 
themselves and the effect their present condition has on their lives. 
Claimants are also encouraged to submit supporting evidence from relatives, 
carers or Health Care Professionals.  This gives the DM a better picture of the 
person's care and mobility needs. Therefore, claims can sometimes be decided 
without medical examination or the need for other information to be obtained. 
Where necessary, further evidence may be sought in the form of a Factual 
Report. DMs are also able to seek medical advice from Health Care 
Professionals employed by Atos Healthcare to provide an interpretation of the 
available evidence.  Atos Healthcare Health Care Professionals are able to 
consult with the Disability Living Allowance Advisory Board (DLAAB) when 
advising DMs. 
There are however situations when a medical examination is required.  In some 
cases a claimant may prefer an Examining Health Care Professionals to examine 
them rather than complete the self-assessment questionnaire.  In other cases, 
the DM may not be able to determine entitlement without a medical examination 
and report to assist in clarifying the evidence. 
6.5 Disability 
criteria 
DLA and AA are both designed to recognise the extra costs incurred from long-
term disability and the care and mobility needs are used as proxies for these 
extra costs.  The basic principles behind the two allowances are the same.  There 
are, however, some significant differences between them. 
 
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6.6 Personal 
care 
To qualify for the lowest rate of the care component of DLA, a person will have to 
be so severely disabled physically or mentally that one of the following apply: 
 Need attention from another person for a significant portion of the day in 
connection with bodily functions for a single period or a number of periods. 
 Aged 16 or over and cannot plan and prepare a cooked meal for themselves if 
they have the ingredients. 
The following criteria refer to the middle and highest rates of the care component 
in DLA: 
 Need frequent attention from another person throughout the day in connection 
with their bodily functions. 
 Need continual supervision throughout the day by another person to avoid 
substantial danger to themselves or others. 
 Need prolonged, or repeated, attention from another person during the night in 
connection with his or her bodily functions. 
 Need another person to be awake for a prolonged period or at frequent intervals 
during the night to watch over them, to avoid substantial danger to themselves 
or others. 
There are also special provisions for people undergoing renal dialysis twice or 
more a week. 
6.7 
Three rates of the care component 
The three rates of the care component are: 
 
CARE COMPONENT RATE 
QUALIFYING CONDITIONS 
Highest 
Payable if the person needs help both day and night, or has 
a life expectancy of six months or less. 
Middle 
Payable if the person needs frequent help during the day or 
night.  Some people who are on dialysis may also get this 
rate. 
Lowest 
Payable if the person needs help for a significant portion of 
the day only, or if aged 16 or over, has difficulty planning and 
preparing a main meal for themselves, given the ingredients. 
6.8 Mobility 
problems 
6.8.1 Criteria for the higher rate mobility component 
A person qualifies for the mobility component at the higher rate if: 
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 He/she is suffering from a physical disablement such that they are unable to 
walk or virtually unable to walk. 
 He/she falls into one of a number of special categories for which it has been 
determined that a higher rate of the mobility component will be payable. 
 This includes people: 
 Unable to walk. 
 Virtually unable to walk i.e. those individuals whose ability to walk out of doors is 
so limited having regard to the distance, speed, length of time or manner in 
which they can make progress on foot without severe discomfort. 
 For whom the exertion required to walk would constitute a danger to their life, or 
would be likely to lead to a serious deterioration in their health. 
 Who have had both legs amputated at levels through or above the ankle, or who 
have one leg amputated and are without the other leg, or who are for any 
reason without both legs to the same extent as if they had been amputated 
either through or above the ankle. 
 Who are deaf and blind to the prescribed degree and, because of the combined 
disabilities, they need help from another person to reach their desired 
destination out of doors. 
 Who are severely mentally impaired and suffer from severe behavioural 
problems and satisfy the conditions for the highest rate of the care component 
as described in paragraph 8.6. 
6.8.2 Criteria for the lower rate mobility 
A person qualifies for the mobility component at the lower rate if: 
 He/she can walk but cannot take advantage of this faculty over unfamiliar terrain 
out of doors without guidance or supervision most of the time (e.g. people who 
are blind or who have learning difficulties). 
6.8.3 Summary of the mobility rates 
The two rates of the mobility component are: 
 
MOBILITY COMPONENT RATE 
QUALIFYING CONDITIONS 
Higher 
Payable if a person: 
1.  Is unable to walk, or 
2.  Is virtually unable to walk, or 
3.  For whom the exertion required to walk would 
lead to a serious deterioration in their health, 
or 
 
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4.  Has had both legs amputated at or above the 
ankle, or 
5.  Is both deaf and blind, or 
6.  Is severely mentally impaired, displays severe 
behavioural problems and is entitled to the 
highest rate of the care component. 
Lower 
Payable if a person can walk but cannot take 
advantage of this faculty outdoors in unfamiliar 
routes without guidance or supervision most of 
the time 
To qualify for the mobility component the person's condition must be such 
that they would benefit from enhanced facilities of locomotion.  For the 
lower rate, the person must be able to go out if they have guidance or 
supervision. 

6.9 Attendance 
Allowance 
To qualify for AA, a person must be so severely disabled physically or mentally 
that they need one or more of the following: 
 Frequent attention from another person throughout the day in connection with 
bodily functions. 
 Continual supervision throughout the day by another person to avoid substantial 
danger to themselves or others. 
 Prolonged or repeated attention from another person during the night in 
connection with bodily functions. 
 Another person to be awake for a prolonged period or at frequent intervals of the 
night to watch over them, in order to avoid substantial danger to themselves or 
others. 
6.9.1 The two rates of AA: 
Attendance Allowance rate 
Qualifying Condition 
Payable if the person: 
Higher 
1.Needs help both day and night, or 
2.Has a life expectancy of six months or less. 
Lower 
Payable if the person needs help during the 
day or night.  Some people who are on dialysis 
may also get this rate 
 
 
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6.10 Qualifying 
periods 
For each component of DLA, the need for help must have existed for at 
least three months and must be expected to exist for at least a further six 
months, unless the claimant is terminally ill. 

For AA the qualifying period is six months unless the claimant is terminally ill.  
There is no requirement to satisfy a future need.   
6.11  Terminal illness cases 
Such cases are dealt with under provisions known as the Special Rules. 
A person, who claims DLA or AA on the grounds of terminal illness, where this 
has been confirmed, is taken to have satisfied the conditions of entitlement for the 
highest rate care component or the higher rate of AA, as appropriate. 
A person is defined in the Social Security Contributions and Benefits Act 1992 as 
terminally ill if they are suffering from a progressive disease and death in 
consequence of that disease can reasonably be expected within six months. 
Disability Living Allowance 
A person claiming DLA on the grounds of terminal illness does not have to satisfy 
the qualifying period or the prospective test for either component. To qualify for 
the higher rate mobility component, they must satisfy one of the relevant criteria 
(see Para 6.8) but there is then no qualifying period. 
Attendance Allowance 
The qualifying period is waived for an AA claim if the claimant is terminally ill. 
6.12  Children under the age of 16 
For children under the age of 16, the disability criteria for DLA are modified as 
follows: 
 For the care component, the child must require substantially more care from 
another person than a child his or her age would normally require. 
 For the lower rate of mobility component, a child (over 5 years of age) must need 
substantially more guidance or supervision from another person than a child of 
the same age in normal physical and mental health would require. 
 The higher rate of mobility components can be considered from the age of three. 
 
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7.  Factors considered by the Decision Maker - 
care 
7.1 Severe 
disability 
For both DLA and AA, the DM must consider if the person's needs arise because 
of physical and/or mental disability. 
The person does not need to be ill or chronically sick. 
7.2 Attention 
Attention is defined as helping someone in connection with his or her bodily 
functions.  Attention must be close and intimate, i.e. spoken or physical and must 
be carried out in the presence of the disabled person.  The important factor is 
whether a particular task is one that a person would normally do for himself or 
herself. 
Examples of bodily functions 
Examples of bodily functions (in DLA and AA) include:  
 Breathing 
 Hearing 
 Seeing 
 Communicating 
 Eating and drinking 
 Walking 
 Sitting 
 Sleeping 
 Cleanliness and skin protection (including being turned in bed) 
 Getting into or out of bed 
 Dressing/undressing 
 Going to the toilet (including undressing, wiping and re-dressing). 
Bodily functions do not include shopping or other domestic tasks, many of which 
would normally be undertaken by a home carer.  Certain tasks, for example 
dealing with soiled bedclothes, can be taken into account if the activity takes 
place at the same time and as part of the activity of attending to the disabled 
person. 
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The DM can take into account attention in connection with a bodily function in 
order to undertake a reasonable level of social, religious or cultural activity. 
7.3 Supervision/watching 
over 
Supervision/watching over is a more passive role than attention.  It means being 
present and ready to intervene, if required, to prevent substantial danger.  By 
night, this can only be satisfied by the need for another person to remain awake 
to watch over the claimant to prevent substantial danger. 
The DM will take account of the following factors when considering the need for 
supervision: 
 The medical condition is such that there might be substantial danger either to the 
disabled person or to someone else. 
 The substantial danger is a real possibility. 
 The need for supervision to ensure that the claimant avoids the substantial 
danger. 
 The need for another person to remain awake to supervise the claimant for a 
prolonged period or at frequent intervals. 
7.4 
The main meal test 
The main meal test is used to establish a person's ability to perform key daily 
tasks and is one of the commonest causes of problems to the DM when they 
analyse EHCP reports. 
 
Key points on the main meal test 
 
  It is not a test of cooking ability but a measure of a person's physical and 
mental capacity to carry out complex activities.  
 

 
  Factors such as the type of facilities or equipment available, or cooking skills, 
are irrelevant.   
 
  Whether a person actually prepares and cooks a main meal is not the issue; 
 
it is whether that person is capable of performing these or similar tasks. 
 
 
 
 
 
 
 
Note: 
 
The use of microwave ovens, prepared meals, frozen vegetables or aids and 
 
appliances other than of a very basic nature wil  not be taken into account. 
 
 
 
 
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Factors to consider are (using appropriate simple equipment and readily 
available aids): 

 
 Planning 

meal. 
  Peeling and chopping vegetables safely. 
  Using the taps safely. 
  Using a cooker safely. 
  Coping with hot pans. 
  Undertaking the process in a hygienic manner. 
The ability to plan a main meal is important.  Some people who have a mental 
disability may be able to carry out all these tasks separately, but may still be 
unable to prepare and cook a main meal because they cannot plan it or 
undertake all the necessary tasks in a logical way without help or supervision.  It 
is, therefore, a test of upper limb functions, manual dexterity, balance and co-
ordination, and mental competence, including motivation. 
7.5 
Are the needs reasonable? 
The DM will take into account what attention or supervision/watching over is 
reasonably required, not what is or is not being received. 
A person may require more care than is being given.  This is of particular 
importance when the needs of people with disabilities living alone are being 
considered.  They may be attempting to carry out activities that are beyond their 
capabilities but circumstances dictate that they must.  Conversely, over-protective 
carers may give a person more help than is needed and therefore prevent them 
from achieving independence. 
When considering the frequency and duration of need for attention or supervision, 
the DM aggregates different needs arising from any particular cause, as well as 
those arising from different causes. 
7.6 Age 
The age of an individual must be taken into account.  A person's age may have 
an effect on how a disability affects them.  For example, a child who develops 
diabetes aged 6 needs more care and supervision than a person who develops 
that same condition when aged 30. 
Many elderly people have more than one disability, which in isolation may not 
seem severe, but the overall effect of the combined and often minor disabilities 
combined with effects of ageing and frailty, may present a significant need. 
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7.7 
Aids to help the disabled 
A further consideration is whether the claimant uses aids to reduce the need for 
help.  For example, a person who would otherwise need help to get upstairs may 
achieve independence with one or two stair rails. 
DMs would not normally take account of what aids a person could but does not 
use.  The exception would be where a person is not using an aid which 
apparently they are able to use, and is readily available and which many others in 
their situation do use. 
Readily available aids are those that cost least and do not require adaptation of 
the home.  For example: blocks to raise a chair, raised toilet seat, adapted 
cutlery, walking stick, and also simple bars, grips and rails.  A commode is 
usually readily available if required.  However, in considering the use of a 
commode the DM must be satisfied that a private place is available in the house 
for its use. 
7.8 Day 
or 
night 
supervision/attention 
The DM will need to consider whether a need arises during the day and/or night.  
The time the disabled person goes to bed is not a factor.  Night has been defined 
in case law as the time the household closes down.  This is particularly important 
when considering the needs of children. 
7.9 Children 
For children under the age of 16, the DM has to decide if the attention or 
supervision/watching over required is significantly greater than that needed by a 
healthy child of the same age.  The main meal test is not applied to children 
under the age of 16. 
7.10 Variable 
needs 
In many conditions, the level of disability varies over time.  Multiple sclerosis is a 
good example of this. Asthma, particularly in children, is another.  These 
conditions are characterised by periods of remission and relapse during which the 
need for help can change greatly.  Other conditions can vary markedly from day 
to day, e.g. chronic fatigue syndrome, whilst others, such as rheumatoid arthritis 
with its morning stiffness may vary throughout the day.   
What is important to the DM is the overall level of disability for the majority of the 
time, not the actual level on a particular day, or the needs during an acute 
exacerbation or period of remission.  
Guidance on the application of disability analysis disciplines and the evaluation of 
evidence particularly in variable conditions will be provided later in this guide. 
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8.  Factors considered by the Decision Maker - 
mobility 
8.1 
Unable or virtually unable to walk 
Inability or virtual inability to walk can be caused by cardiac or respiratory 
disorders or disorders affecting the balance as well as disabilities directly 
affecting the lower limbs. 
Only the effects of physical disability can be taken into account when deciding if a 
person is unable or virtually unable to walk.  A person who refuses to walk for any 
reason but can walk if persuaded would not normally be regarded as incapable of 
walking.  The decision on whether a person’s inability to walk arises from a 
physical disability can be complex and is one for the DM to make, taking account 
of various legal precedents.  The important thing is to record as much detail as 
possible about the individual and the way his/her walking is affected, in order to 
allow this decision to be made in a reasonable way. 
In assessing the level of walking ability, no account is taken of the person's 
individual circumstances such as: 
 Where they live. 
 Whether they have access to public transport. 
 Whether they work. 
 What type of work they do. 
Factors that are taken into account (walking on even terrain out of doors without 
severe discomfort): 
 Distance    
 
 Speed 
 
 Length of time 
 Manner   
 
No one factor is decisive. 
8.2 Exertion 
A person whose legs are capable of the physical movements of walking but who 
is prevented from doing so because of other physical problems can be regarded 
as unable or virtually unable to walk if: 
 The effort required to walk would endanger his/her life; or 
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 It would be likely to have an adverse effect on his/her health. 
8.3 Amputations 
People who have had both legs amputated at or above the ankle and people 
without the use of both legs are taken to be unable to walk irrespective of their 
actual ability to walk using prostheses. In these cases, the DM will look for 
appropriate corroboration.   
Unless there are potential care needs, examination is not normally necessary. 
8.4 Walking 
aids 
When assessing a person's walking ability with walking aids, consider the 
following factors: 
 The use of appropriate prostheses or aids already supplied (except for a person 
without both legs to the same extent as if they had been amputated) or which 
could be supplied, and 
 Whether they are mentally and physically able to use them. 
 Ability to weight bear on the aid. 
 Where only one lower limb is weight bearing then the method of progress using 
crutches is "swinging-through".  This does not constitute walking. 
8.5 
Deafness and blindness 
People who are both deaf and blind as defined below and (as a result of the 
combined disabilities) need the help of another person to reach an intended or 
required destination, are regarded as unable to walk and hence will qualify for 
higher mobility component. 
The prescribed degree of disability due to blindness is 100%.  This is defined as 
loss of sight to such an extent as to render the claimant unable to perform work 
for which eyesight is essential.  This normally equates to a visual acuity of <6/60, 
or inability to count fingers beyond 50 cm.  However, other factors, for example 
the extent of any visual field loss should also be taken into account. 
The prescribed degree of disability due to deafness is 80%.  Clinical tests should 
confirm that the claimant is not able to hear and understand a shouted message 
at a distance of one metre, out of doors (i.e. with an element of background 
noise). Case law has established that DMs will normally be required to establish 
the level of hearing impairment by means of an audiogram and applying a similar 
type of assessment to that taking place in occupational deafness in the Industrial 
Injuries Disablement Benefit. 
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8.6 Severe 
mental 
impairment 
A small number of people with severe mental impairment (SMI) who are 
physically able to walk also have behavioural problems.  These may be so 
extreme and unpredictable that they need someone to be present watching over 
them whenever they are awake and that person regularly needs to intervene and 
physically restrain them to prevent injury or damage.   
This group has been described in the regulations as those who have arrested or 
incomplete physical development of the brain, which results in severe impairment 
of intelligence and social functioning, to the extent that they have severe 
behaviour problems and qualify for the highest care component.  If all these 
conditions are satisfied, they will qualify for the higher rate of the mobility 
component. 
Severe impairment of intelligence can be generally described as being 3 standard 
deviations below the average IQ of 100. Therefore, usually, a person with severe 
impairment of intelligence will have an IQ of 55 or less. However, whilst IQ is a 
good starting point in determining intelligence, it is useful intelligence that has to 
be considered. For example, an autistic person, with an IQ of 80 and who is a 
brilliant musician, may lack sufficient social skills to make use of this intelligence 
in other areas. 
Incomplete physical development of the brain refers to the situation where a 
person's brain has failed to grow in the proper way and this can be demonstrated 
physically.  On examination of a person's brain, where nothing appears physically 
wrong, but the function of the brain is nevertheless deficient, then development is 
said to be arrested.  The current consensus view is that the brain reaches full 
development in most people in the late twenties, and invariably before the age of 
30 years. 
It is therefore possible for someone who suffers an insult to the brain before the 
age of 30 years to be considered severely mentally impaired.  It may also be 
possible for some people who develop severe mental illness before the age of 30 
to be regarded in this way, if the illness can be identified as arising from arrested 
or incomplete physical development of the brain.  Conditions that develop after 
the age of 30, including degenerative conditions such as Alzheimer's disease, 
would not be considered to have caused severe mental impairment because the 
problem arose after the brain was fully developed.  However, it will always be 
necessary for the other conditions relating to intelligence and social functioning to 
be fulfilled before a person can qualify for a higher rate mobility award. 
The above conclusions have been defined by case law and must be accepted for 
decisions relating to DLA/AA. 
8.7 
Guidance and supervision 
There are many severely physically or mentally disabled people who are 
physically capable of walking but are not independently mobile on foot.  They 
may need guidance from another person or may need supervision most of the 
time because they: 
 Have impaired vision and cannot find their way. 
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 Do not recognise danger. 
 May injure themselves or others. 
 May get lost or forget where they are going. 
 Need active encouragement or persuasion to continue walking. 
Any ability to follow well-known routes without help is discounted, such as going 
to a local shop or the use of a bus service regularly.  Any supervision that is not 
directed towards helping the person find their way must also be discounted. 
8.8 Intermittent 
problems 
When a person's walking ability varies or the need for guidance or supervision is 
intermittent, the level of disability over a period of time will be taken into account 
when determining the claimant's overall needs. 
When a person's walking ability is intermittently interrupted, e.g. if they have 
epilepsy, it is a question of degree and frequency as to whether or not they can 
be considered to satisfy the conditions for an award.  (Such a person may require 
assessment as under Paragraph 8.7 above, but with due regard to the purpose of 
any supervision required.) 
In situations where there is considerable variability, it is vital to give as much 
information as possible to the DM.  It is helpful to record, if possible, details of the 
status on good and bad days and the frequency of good/ bad days etc.  
8.9 Children 
Guidance or supervision needed for children (up to the age of 16) has to be 
significantly greater than that required for a healthy child of the same age. 
8.10  Benefits of getting out and about 
In addition, the DM must take into account whether or not the person will benefit 
from getting out.  This relates to general mobility and is not confined to the act of 
walking. In general terms, a person may be considered able to benefit if they are 
in any way conscious of change.  A person who can walk but needs guidance or 
supervision to walk out of doors must be willing to go out to be able to benefit. 
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9. 
Equal Opportunities and other legislation 
9.1 
Equal Opportunities Policy 
As an EHCP acting on behalf of Atos Healthcare you are expected to adhere to 
the Equal Opportunities Policy.  In all aspects of our work, there is no place for 
any suggestion of discrimination or harassment.   
9.2 
Race Relations Act 1976  
The Race Relations Act 1976 makes it unlawful to discriminate against 
individuals on the grounds of: 
 Colour 
 Race 
 Nationality 
 Ethnic  origin 
 National  origins. 
Discrimination occurs whenever a person, on racial grounds, treats an individual 
less favourably than others.  In addition, discrimination occurs if a person applies 
a requirement or condition that cannot be justified irrespective of race.  
It is our practice to inform claimants that if they have difficulty understanding 
English then an interpreter may accompany them.  An interpreter should be 
present if language difficulties would make it difficult for you to make a proper 
assessment of a claimant’s condition.   
If it is evident that an interpreter is required, you should explain matters as best 
you can to the claimant. In the MEC, the MEA should be informed. If this situation 
arises on a DV, then the MSC should be telephoned. Arrangements will then be 
made for the assessment to be performed later, when an interpreter will be 
provided. Note that a minor (child under 16 years old) is not an appropriate 
interpreter, and alternative arrangements should be made. 
9.3 
The Sex Discrimination Act 1975 
The Sex Discrimination Act 1975 makes it unlawful to discriminate against 
anyone or treat anyone less favourably on grounds of gender.  
If a justified complaint is received that an individual has been discriminated 
against on the grounds of race or gender, that Medical Practitioner will no longer 
be used to carry out examinations. This action may be in addition to any civil 
proceedings that the claimant may wish to bring. 
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9.4 
The Rehabilitation of Offenders Act 1974 
9.4.1 Background 
Under the Rehabilitation of Offenders Act 1974, after the expiry of a rehabilitation 
period, a conviction becomes ‘spent’. The rehabilitation period varies in length, 
depending on the sentence imposed; some sentences can never be spent. Once 
a conviction becomes spent, the person is treated for a number of purposes as if 
they had never been convicted of the offence in question. 
The Rehabilitation of Offenders Act makes it an offence for anyone with access 
to criminal records
 to disclose a spent conviction unless authorised to do so
The intention of the legislation is that once a conviction becomes spent, any 
question relating to criminal convictions in, for example, job or insurance 
application forms, can, with certain exceptions, be answered in the negative. 
Only malicious allegations of spent convictions would carry a risk of legal action 
for defamation of character, if it could be proved by the claimant that the 
allegation was made with malice. 
9.4.2 Implications for Examining Health Care Professionals 
Atos Healthcare practitioners may receive information that relates to current or 
spent criminal convictions, either in factual reports from a third party, e.g. a GP, 
or directly from the claimant during interview. Therefore, we need to understand 
the implications of the Rehabilitation of Offenders Act so that this information can 
be dealt with appropriately. 
If a report submitted to the DWP or Atos Healthcare by a third party refers to a 
criminal conviction, the author will not contravene the Act unless they have 
access to the person’s criminal records. In the case of a factual report from a GP 
or hospital, this risk would be so unlikely that it can reasonably be disregarded. 
The information in such a report is likely to have come from the claimant. 
Therefore, Atos Healthcare Practitioners can accept in good faith that reference 
to criminal convictions in third party reports does not risk contravening the 
Rehabilitation of Offenders Legislation. However, such information should be 
treated like any other potentially embarrassing information, unless mention of the 
conviction is directly relevant to the benefit claim in question. 
Similarly, since neither the DWP nor Atos Healthcare will normally have access to 
a person’s criminal record, any information about convictions will have come from 
the claimant. Hence, if there is good reason for the EHCP to record such 
information – i.e. it is materially relevant to the claim – then he or she may do so, 
in good faith, without fear of contravening the legislation. If a claimant wishes to 
have mention of a conviction recorded on the medical report, the EHCP should: 
 Confirm with the claimant that they are content for the information to be 
disclosed in the report; and 
 Record the information together with a note stating, “I confirm that this 
information has been incorporated at the request of the claimant.” 
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9.5 
The Disability Discrimination Act 1995 
The EHCP is not required to provide an opinion on whether the claimant’s 
medical condition or disability is likely to satisfy the Disability Discrimination Act 
[DDA] 1995.  
Under the DDA, it is unlawful to treat a person less favourably than another 
because of their disability.   
The Act covers: 
 Employment 
 Education 
 Access to premises used by the public 
 Provision of goods, services and facilities 
 Accommodation 
 Buying premises including land 
 Clubs and associations 
 Sport 
 Administration of Commonwealth Government Laws and Administration 
9.5.1 Definition of  Disability within the DDA 
Disability within the meaning of the Act is defined as follows: 
A physical or mental impairment, which has a substantial and long-term 
adverse effect on that person’s ability to carry out normal day-to-day 
activities. 

When considering if the DDA applies, the underlined areas are important. 
Impairment may be physical or mental, due to illness, accident or congenital 
abnormality. Mental impairment includes mental illness (but this does not need to 
be clinically well-recognised) and learning difficulties. It excludes certain 
conditions such as a tendency to criminal or sexual acts. 
Impairment will affect normal day-to-day activities only if it has an adverse effect 
on one of the following: 
 Mobility 
 Manual dexterity 
 Physical co-ordination 
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 Continence 
 Ability to lift, carry or otherwise move everyday objects 
 Hearing, speech or corrected eyesight 
 Memory or ability to concentrate, learn or understand 
 Perception of risk of physical danger 
Substantial is defined as more than minor or trivial. Therefore the presence of 
impairment, limited activity and/or reduced participation (as per the International 
Classification of Functioning, Disability and Health) does not necessarily mean a 
person is covered by the Act. For example, a pianist who loses part of their little 
finger would not fall within the meaning of the Act since this would not cause a 
substantial effect on their ability to perform the activities of day-to-day living.  
Long Term includes the following: 
 Has lasted at least 12 months 
 Is likely to last 12 months 
 Is likely to last the rest of the person’s life (including terminal illness) 
 Is likely to recur 
When a person has a progressive condition, that person will be covered by the 
Act from the time the condition leads to an impairment which has some effect on 
ability to carry out normal day-to-day activities, even though not a substantial 
effect, if that impairment is likely eventually to have a substantial adverse effect 
on such ability. In addition, cancer, multiple sclerosis, and HIV infection are 
recognised by the Act from the point of diagnosis. 
When considering if a person falls within the meaning of the Act it must be 
remembered that a person is still protected against discrimination even when 
their disability is controlled or treated. They are considered without the effects of 
any treatment. For example, a person with epilepsy is considered without their 
medication. 
HCPs are referred to Module 5 of the Medical Services Continuing Medical 
Education Programme entitled ‘The Disability Discrimination Act’, for more detail 
on the DDA. 
 
 
 
 

 
 
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10.  Administrative guidance for the EHCP 
This chapter describes the issues relating to examinations performed as 
domiciliary visits. 
10.1  Making appointments for domiciliary visits 
 
 
Key points: 
 
 
  Arrangements for DVs are a major source of complaints against EHCPs, 
 
particularly regarding alleged insufficient notice of a visit. 
 
 
  It is very important to follow the recommend practice as described below. 
 
 
EHCPs are asked to note the following points when undertaking examinations in 
the claimant’s home: 
 Contact the claimant and offer an appointment for a visit as soon as possible 
after receiving a file.  This appointment can either be made by a telephone 
and / or a letter.  It is vital to offer sufficient (7 days) notice to allow: 
a.  The claimant and relatives or carers time to prepare for the examination. 
b.  To ensure the presence of an interpreter if needed. 
c.  A parent or legal guardian to be present when examining a claimant below 
the age of 16 years. 
d.  When an appointment has been made by telephone, it is good practice to 
confirm the appointment by letter. 
e.  When contacting the claimant by telephone the procedures outlined in 
section 10.2 should be followed. Ensure telephone calls are made at 
reasonable times. 
f.  When notifying a claimant of an appointment time, a maximum of a 1-hour 
window should be given. All reasonable efforts should be made to attend 
within that time. If you are running late or are unable to keep the 
appointment, it is important that the claimant is contacted to keep them 
informed. 
  When an appointment is discussed on the telephone and a date less than 7 
days in advance is agreed as being mutually convenient, the EHCP should 
record this fact on the report, and ask the claimant to sign that it is the case.  
(Please Note: Some claimants allege that they were pressurised by the EHCP 
into accepting such appointments therefore recording the facts on the report can 
be important.  It is very important to be aware of the sensitivities surrounding 
ensuring that the appointment time is mutually convenient). 
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 Provide proof of identification for the claimant/carer as issued via your Medical 
Manager. 
 Ensure that the person being interviewed and assessed is the person claiming 
benefit (see section 10.3). 
 Return reports promptly within the agreed period, and make contact by 
telephone with the MSC if this is not possible. 
10.2  Telephone contact with claimants 
It must be ensured that Atos Healthcare complies with the Data Protection Act 
(DPA) when contacting claimants or their Appointees by telephone. It must be 
followed by all persons either working for or on behalf of Atos Healthcare. 
In all instances where contact is to be made with a claimant, the procedure 
outlined below should be followed.  
10.2.1 
Establishing the identity of the claimant 
When making the telephone call it is essential that the identity of the person to 
whom the EHCP is speaking is established at the outset. 
The following script or something very similar should be used: 
“I’m XXX from Atos Healthcare and I would like to speak to Mr/Mrs/Miss/Ms (Use 
Full Name of Claimant)”.  No further details should be given until the claimant has 
been positively identified. 
A positive identification of the claimant should be sought and this would normally 
be the date of birth or NINO.  
If you are uncertain that the person to whom you are speaking is the claimant, 
terminate the call. 
If the claimant is unavailable, arrange to call back, without revealing any further 
details appertaining to the nature of the telephone call. If the claimant cannot be 
contacted via the telephone then an appropriate letter should be used. 
10.2.2 
Informing the claimant of the reason for the telephone call 
Having established the identity of the claimant, there is then a need to explain 
why the telephone call is being made. Something similar to the phrase, “I am one 
of the medical practitioners providing medical advice on your claim to benefit” 
would suffice. 
10.2.3          Form FRR4 – Telephone Contact report for Further Information of 
Further Medical Evidence 

Form FFR4 is to be used to cover documentation of all information and 
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evidence obtained in the course of a telephone call. This would not normally 
be part of an EHCP’s role. 
 
10.2.4 Exceptional 
circumstances 
There may be instances when the above procedure cannot be used because the 
claimant: 
 Is a child. Under these circumstances, once contact has been made with a 
parent or guardian, a check should be made that the parent or guardian is the 
correct person to whom we should be speaking by verifying name and 
address details that are held on the referral.  The identity of the child must 
then be checked by asking the parent or guardian to confirm the child’s name 
and date of birth.  Once satisfied that it is the correct child that is to be 
discussed, further information may then be divulged. 
 Has an Appointee. If the referral shows that the claimant has an Appointee, a 
check should initially be made to verify that we are talking about the correct 
claimant by checking the date of birth, address and NINO.  Once this is 
confirmed, the person who claims to be the Appointee should be asked for 
verification of their name and address that will be shown on the referral. 
Further information may then be divulged. 
 Requires an interpreter. If, when making a telephone call to the claimant, it 
becomes obvious that an interpreter is required, the EHCP should advise the 
person to whom they are speaking that a letter will be sent to the claimant in 
due course.  The telephone call should be terminated without divulging any of 
the claimant’s details. 
 Has a medical condition that precludes a telephone conversation.  As in the 
case of an interpreter, once it becomes obvious that the claimant cannot 
speak on the telephone the EHCP should advise the person to whom they are 
speaking that a letter will be sent to them in due course.  The telephone call 
should be terminated without divulging any of the claimant’s details. 
If any of these circumstances arise whilst contact is being made by telephone, 
greater care must be exercised to ensure that we remain within the confines of 
the Data Protection Act. 
10.3  Identification of the claimant at the assessment 
Contractually, Atos Healthcare is required to ensure that individuals presenting 
themselves for examinations are who they say they are. Atos Healthcare must 
examine the actual claimant, not any person who may be masquerading as the 
claimant. Therefore, reasonable steps must be taken to ensure that we are 
fulfilling the Customer’s wishes. 
The form POID1 should be used. An example of this is in Appendix F.  
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The MSC must complete the name and date of birth of the claimant at Part 1 and 
ensure that this form is then enclosed in the file/plastic wallet that is issued to an 
EHCP for a DV. The steps outlined below should be followed: 
 The EHCP should identify themselves, who they visiting and the reason for the 
visit. 
 Ask the claimant to provide identification such as a passport or driving licence. 
 Circle the evidence provided on the form. 
 Ask the claimant to sign the POID1. 
 As an additional cross check, compare the signature to the claim form (e.g. DLA 
1 etc., if available) or the proof of identity offered, if signed 
 Complete Part 2A of POID1 by ticking ‘N/A’.  Then complete 2 B. 
 Place the POID1 into the claimant’s file. 
If the claimant’s signature does not match the claim form but the claimant has 
produced an acceptable form of identification the EHCP should ask the claimant 
more in depth questions relating to case history, to establish correct identity and 
determine whether the examination should continue. If the EHCP is 100% certain 
that the individual is not the true claimant, they should contact a FTMA or Medical 
Manager to authorise suspension of the examination.  This should be done by 
telephone, either mobile or pay phone if necessary. 
An individual must not be refused an examination unless the EHCP is 100% 
certain that the individual who has presented him or herself for examination is not 
the true claimant. In all other cases the EHCP should continue with the 
examination and complete the medical report as normal, marking the report that 
the claimant’s identity is in doubt. 
10.4  Special need requirement  
Occasionally a claimant will request that, for example, a same sex EHCP 
performs the assessment, or that an interpreter be provided (e.g. for language, 
for the deaf, etc.)  This fact is registered on the documents by the Customer, for 
administrative action by Atos Healthcare Centre (MSC) staff. 
The general principle is that it is the responsibility of the MSC to make the 
necessary arrangements according to the nature of the special needs, and act as 
the point of liaison.  
In the first instance, the Allocation Section will select an appropriate EHCP in the 
area. This may be all that is required, e.g. in the case of the claimant who 
requests a same sex EHCP or if there is a suitably qualified EHCP that speaks 
the required language. This will usually be the case when the claimant is 
examined at an MEC. 
Where an interpreter is required for a MEC based examination, this will be 
arranged by the Allocation Section as necessary. 
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Where an interpreter is required for a DV, the Allocation Section will alert the 
selected EHCP by telephone to expect the case. The Allocation Section will then 
proceed to identify an appropriate interpreter in the area, determine the 
interpreter’s availability and obtain their agreement in principle to provide 
assistance. The Allocation Section will then raise a Purchase Requisition with the 
Finance section and complete it appropriately.   
The Allocation Section will then post the annotated file to the EHCP, who makes 
a general arrangement with the claimant to perform the visit, and provisionally 
agrees a suitable day and time.  
Clearly, it is helpful if the EHCP and claimant between themselves provide the 
MSC with a choice.  If the claimant is unable to speak or understand English, the 
EHCP should notify the Allocation Section and give details of their availability.  
The Allocation Section will then contact the interpreter, giving the EHCP’s 
availability and ask them to telephone the claimant to arrange a mutually 
agreeable appointment.  The interpreter should then notify the Allocation Section 
of the agreed date and this information should be passed to the EHCP.  
If an interpreter has not been required to arrange an appointment, time is allowed 
for the EHCP to contact the claimant.  The Allocation Section will then telephone 
the EHCP to ascertain the proposed date and time for the visit.  The interpreter 
should then be contacted to inform them of the arrangements and confirm that 
they are suitable. 
Once all parties are content with the arrangements, the EHCP should then 
confirm the proposed time and date with the claimant, preferably by phone and 
letter.  If an interpreter has been used to make these arrangements then the 
same interpreter should be contacted to convey this information to the claimant.  
In this circumstance, a telephone call should be sufficient. 
If the arrangements are upset by unexpected events or difficulties, the Allocation 
Section will be the point of contact for all parties. 
If the EHCP undertakes the visit and at this point identifies that an interpreter is 
required they should send the file to the Allocation Section for them to return it to 
the business unit for further information on required special needs. 
Targets may be compromised by cases of this type. The following principles 
should be observed: 
 It is essential that EHCPs remain aware of the constraints imposed by targets 
and make every effort on their part to ensure that the medical arrangements 
are put in place as efficiently as possible and with the minimum of delay. 
 The Allocation Section must be kept up to date with all developments. 
10.5  EHCP reports completed by a third party 
No report for Atos Healthcare can be hand-written by anyone other than 
you as an EHCP. 

A typewritten report, typed by a third party, is acceptable because it can be 
understood that the EHCP would have dictated that part of the report to their 
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secretary before checking and signing the typed and completed form. 
A typist (or indeed a wife/husband) engaged by an EHCP to complete a medical 
report is liable to prosecution for any breach of confidentiality from information 
they would gather or become aware of while typing reports.  This arises under 
Section 123 of the Social Security Administration Act of 1992. 
The Legal Advice is that a secretary, being a person who provides or is employed 
in the provision of a service (typing reports) to persons who are carrying out the 
administrative work of the Department (i.e. an EHCP) would fall within the 
provisions of the Act.  
They would therefore be susceptible to any prosecution for any breach of 
confidentiality.  This applies irrespective of whether or not the typist is an 
employee, or has signed a separate confidentiality agreement for other employed 
work, or is a spouse, partner, or friend of the Examining Health Care 
Professional.   
Depending on the seriousness of the breach, it cannot be ruled out that the 
Department would also seek to prosecute the Medical Practitioner for using 
unauthorised staff in the generation of their reports and in the utilisation of the 
information.   
The following procedure should be followed for the typing of reports: 
 You should arrange for signature and retention of copies by both parties, of 
appropriate confidentiality undertakings by those you engage with for 
processing information. 
 If you use the services of a typist, please write to your local Medical Manager to 
confirm that you have put a confidentiality agreement in place.  Please send a 
copy of that letter to the VPPC. Please make sure that you enclose a copy of 
the signed confidentiality agreement in both letters as well as the name and 
address of your typist.  When the correct documentation is in place, Atos 
Healthcare will send you a letter of permission to use the services of the 
particular typist and will retain copies of these documents on your personal 
file.  This procedure will need to be repeated on any change of typist. 
 Failure to obtain an appropriate confidentiality agreement may mean that you, 
the EHCP, may also run the risk of prosecution under The Act in the event of a 
breach of confidentiality by any unauthorised personnel with whom you have 
engaged.  
10.6  Abortive visits (no report provided) 
Inevitably, on some occasions EHCPs will make abortive visits when the claimant 
is not at home at the pre-arranged time. The procedures for dealing with such 
situations are to: 
 Complete form AV1 (Appendix D) and leave that at the claimant’s address.  This 
form allows you to input the new details of when you will call again. You 
should arrange the second appointment within the specified target time 
(usually 15 days from the time the papers were dispatched from the MSC, 
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unless otherwise stated).  As 7 day’s notice will have previously been give for 
the first appointment, it is not a contractual requirement to do so again.  You 
should ensure that the claimant is given reasonable notice for the second 
appointment in the event that they wish to arrange for a representative to be 
present.  If you are unable to complete the report within the specified 
timescales, contact the MSC for advice. 
 
 In some special situations, cases will be marked by the DBC with a red star.  In 
such situations use form AV2 (Appendix D). 
 Fill in Page 2 – about the visit of the EHCP report form giving reasons for the 
aborted visit (see below) 
 If the property looks uninhabited or you feel that the address may not be correct, 
telephone the MSC for advice, so they can confirm the address with the DBC. 
 If, when you visit again, the claimant is still not at home, fill in the appropriate 
part of Page 2 - about the visit and return the file to the MSC. 
 Please record details of time and date of telephone conversations in the space 
provided at the bottom of Page 2. 
 Please Note: only two attempts should be made to examine the claimant. 
In the above circumstances, please provide full details of the reasons why you 
were unable to complete the form. 
 
Examples of good practice in completing Page 2 – about the visit would be:  
“I was unable to complete the EHCP report form because on the first occasion 
the claimant, who was profoundly deaf and who understood sign language, did 
not have a signer available.  A signer was arranged for the second visit but was 
not present due to transport problems” 
“I was unable to complete the EHCP report form because the claimant advised 
that he did not feel well enough to be examined on both occasions that I visited.  
The claimant refused to elaborate when I asked him for further details of why he 
did not feel well enough and advised that under no circumstances would I be 
given access to the house” 
The following would not be sufficient: 
“The claimant advised that he would not be examined” 
Under no circumstances should you refer to the risk to benefit status. The Data 
Protection Act requires that you only include information on third parties that is 
relevant.  Please attempt to anonymise any reference to third parties should it be 
necessary to include it. 
For example:  
“The claimant refused to allow me access because she said that she had to take 
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her elderly relative to the hospital on both occasions when I called” would be 
acceptable. 

However:  
“The claimant refused to allow me access because she said that she had to take 
her mother to the hospital on both occasions when I called” would be 
unacceptable. 

10.7  Non aborted visit (report incomplete) 
When the claimant provides an account of their condition(s) and typical day, but 
is unable to co-operate fully in allowing you to carry out a physical examination 
AND you do not have sufficient information to confidently provide an opinion on 
mobility and/or care needs, this situation will apply. 
This situation is likely to arise on the rare occasion when the claimant says they 
are, for example, too ill, or in too much pain, or it is a “bad day.”  In this case, ask 
the claimant to sign a statement that records they are unwilling to be examined.   
Under clinical findings in the report, please record your informal observations so 
that the Decision-Maker has some information on which to assess care and 
mobility needs. Wherever possible give your opinion, explaining that this is based 
upon informal observations only, at Section 3, box 21 of the form, in the box 
entitled “Please add any further information that you think would aid the decision 
maker”. 
In the above circumstances, please provide full details of the reasons why you 
were unable to complete the form on page 2 of the report form. 
10.8  The claimant refuses you entry 
An attempt should be made to negotiate a mutually convenient time for a further 
visit.  Ensure the claimant is given reasonable notice for the second appointment 
in the event that they wish to arrange for a representative to be present. 
If the claimant refuses to agree a further appointment, you should inform them 
that you are obliged to attempt two visits to complete the report and provide a 
date and time on which you will return.   
If on the second visit the claimant either is not at home or refuses you entry 
complete Page 2 of the EHCP report form – about the visit and provide the dates 
of the aborted visits. 
10.9  Carrying out a requested DV where the Claimant is a Hospital 
In-patient 

In rare circumstances Atos Healthcare are asked to carry out an assessment for 
DLA/AA, in the knowledge that the claimant is a hospital in-patient.  
More often, this information will only become available when attempts are made 
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to secure the appointment. 
The in-patient status of a claimant may suggest a significant level of disability.  In 
these cases, it should have been considered whether an examination is still 
essential, or whether information could be obtained from other sources to provide 
advice to the Decision Maker. 
If the claimant is expected to be an in-patient for less than 4 weeks, it would often 
be appropriate to defer examination for a suitable period until the claimant can be 
assessed at home
10.9.1 DV request for a known in-patient 
In these cases, it will advise you on form DBD313a that the claimant is known to 
be in hospital. 
In this case you should continue to arrange the visit but the following guidance 
must be adhered to: 
1.  The consent of the supervising consultant is mandatory.  The consultant 
must agree that the visit can proceed, and that the claimant is fit to be 
assessed. 
2.  A relative or friend of the claimant must be present during the assessment 
unless the claimant expressly declines the presence of a companion. 
3.  The fact that consent has been obtained from both the consultant and 
claimant should be recorded in the report. 
10.9.2 Other situations 
Often, the information that a claimant is an in-patient will only become apparent 
when attempts are made to secure an appointment. 
In this situation you should: 
1.  Contact the scheduling section and advise them of your findings. 
2.  Provide any information that you may have discovered about the reason 
and likely duration of their stay. 
3.  Hold the file pending further advice. 
If you are asked to: 
a.  Return the file: 
Please return the file to the Atos Healthcare scheduling section marking 
form DBD313a ‘Claimant identified as an in-patient’ and providing any 
information that you may have discovered about the reason for, and likely 
duration of, their stay. 
b.  Arrange the visit in hospital: 
Please see the guidance in section 10.9.1 above 
c.  Hold the file and arrange an appointment when the claimant is expected to 
return home: 
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Follow the guidance from the Atos Healthcare Scheduling section and if at 
the second attempt to arrange an appointment the patient remains in 
hospital you should return the file to the Scheduling section following the 
guidance for an abortive visit (no report provided) at Section 10.6 above. 
 
 
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11.  Recommended approach to Disability 
Assessment 
There are some significant differences between the disability analysis 
examination and assessment and that performed in General Practice and 
hospital settings.   A comparison of the roles of the Clinicians and the Disability 
Analyst is shown below in 11.1. 
11.1  Comparison of role of Clinicians and Disability Analysts 
 
 
CLINICIAN 
DISABILITY  
(GP/CONSULTANT) 
 ANALYST 
ROLE 
 Diagnose 
Assess: 
 Treat 
- Functional limitations/ 
restrictions (IB) 
- Care needs (DLA/AA) 
    -  Resulting from an illness,          
accident or impairment (IIDB) 
HOW 
History 
History 
 Concentrate on presented 
  Diagnosis from clinician 
symptoms 
  Brief history of illness 
  Need for consistency is not a key 
  Symptoms – how illness affects: 
feature 
 Function 
 
  Daily living activities 
 
  Looks for consistency in the 
 
overall picture 
 
 
Examination 
Examination 
  Focussed on making, or 
  Informal observations often very 
confirming, the diagnosis 
important 
  Informal observations not always 
  Objective examination looking for 
noted 
consistency and inappropriate 
signs (findings that do not indicate 
disease) 
SPEFICIC 
 Diagnostic techniques 
  Objective assessment “disability” 
SKILLS 
  Detailed knowledge of therapeutic    Opinion/advice has to be fully 
options 
justified for DM 
  Knowledge of legal framework 
when giving advice 
OTHER 
Usually the patients advocate 
Not acting as patient’s advocate 
  Acting in their best interest 
  Objective advice given in 
 Practitioner/patient relationship 
accordance with the law 
  Advice based on a detailed 
functional assessment 
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11.2  Disability analysis in DLA/AA 
When carrying out DLA and AA examinations it is important to bear in mind: 
 The contact with the claimant will be on a “one off” basis rather than as part of 
an ongoing professional relationship. 
 The diagnosis has a different emphasis than it does in the clinical or therapeutic 
situation.  It is however an important starting point for assessing the expected 
effects of the disability. 
 It is vital to form and express your opinion on the effects of disability on that 
individual’s daily life.  In doing so, it is necessary to resolve any conflicts 
between what the claimant says and what would normally be expected from a 
particular disability.  This is achieved by checking for consistency and 
determining whether the picture fits with the consensus of informed (and if 
possible evidence-based) opinion on the subject.  Such an approach is the 
essence of disability analysis.   
 Information can be elicited from several sources: the case papers, the claimant, 
relatives or carers, indirect observations and direct clinical examination. 
 Full physical examination may not be required & is often unnecessary.  
 The EHCP report should be based on an impartial and objective assessment of 
the claimant.  It must be set out in the appropriate manner, and be easily read 
and understood by a non-medical person.  The report should be internally 
consistent, and any apparent contradictions explained.  Such contradictions 
may arise from the discrepancies between information given by the claimant 
(either in the claim form or verbally) and your subsequent opinion based on an 
overall assessment. 
11.3  Definitions of disability and impairment 
Disability analysts should understand the concepts of impairment and disability. 
 
Key points 
 
  Impairment is defined as: "Any loss or abnormality of psychological, 
physiological or anatomical structure or function".  
 
  Disability is defined as: "Any restriction or lack of ability, resulting from 
 
impairment, to perform an activity in the manner or within the range 
considered normal for a person of the same age and sex". 
 
  Disability analysts should interpret not what is wrong with the person but 
the functional limitations and restrictions which determine what the person 
is prevented from doing.  People with the same impairment can have very 
different disability. 
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Page  48 
 
 

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12.  Completion of reports 
12.1 Introduction 
 
Key Points 
 
  A written report must be completed legibly and must be in black ink as 
 
this makes it easier to photocopy. 
 
  The report must be understandable to non-medical DMs and should not 
include complex medical terms or abbreviations without a clear 
 
explanation of meaning. 
 
  Questions with Yes/No boxes must be ticked. 
 
  Comments boxes must be completed whenever possible. 
 
  Record start and end times of the assessment (arrival and departure for 
DVs). 
 
 
  Record those present during the assessment and their relationship to the 
claimant. 
 
  Any extra questions asked by the DM should be addressed. 
 
Reports are requested in the following circumstances: 
 The claimant has requested a medical examination. 
 Insufficient evidence has been obtained from other sources. 
The report form is divided into 3 sections: 
 Section 1 – Claimant’s account of their disabilities recorded by the EHCP 
 Section 2 – Clinical findings 
 Section 3 – EHCP’s opinion regarding the claimant’s function 
For children it is important to report not only what care and/or mobility needs 
there are, but how these may differ from those of a healthy child of the same age. 
Any measurements given must be recorded in metric units.  If imperial units are 
used on a document that is part of the adjudication evidence, the DMs decision 
will be vulnerable to challenge.  Estimates of distance, height and weight given by 
the claimant should be recorded in the stated units and not converted by the 
EHCP.  
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9 Final 
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Page  49 
 
 

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12.2  Recording information from the claimant 
Some people will maximise their needs but others, particularly the elderly often 
minimise the amount of assistance that is needed or the difficulties they have in 
getting help.  It is important that all help and assistance given is recorded.  
Conduct the interview, when possible, in the presence of the carer or relative and 
note the identity of that person in the report. 
As an experienced medical practitioner, you will be well aware that some 
individuals find it difficult to express their problems in a clear and concise 
manner.  Your role therefore is to help the claimant give as complete an account 
as possible of the help that the claimant/carer feels is needed.  As the claimant 
may find it difficult to put this into words, a patient, relaxed attitude by the EHCP 
is important. 
See the carer or relative alone if appropriate, to discuss facts that may not be 
known to the claimant, or are too embarrassing for the claimant to disclose. 
This makes it possible to correct false impressions given by the claimant who 
may be unclear as to the amount of help needed.  This situation can apply if the 
claimant is elderly, has severe learning difficulties, or a mental illness. 
Claimants may also be reluctant to discuss bodily functions.  Those with disability 
due to a mental impairment may not be clear of their actual care and mobility 
needs.  
Please ensure that you adhere to the Atos Healthcare Professional Standards, 
recommended procedures set out in these guidance notes. You must also 
adhere to Equal Opportunity and any other relevant legislation.  
In the interests of natural justice, if a claimant is already known to the 
EHCP as a patient (either past or present), then arrangements should be 
made for that claimant to be seen by another EHCP. 

When recording information in the EHCP report form complete all of the boxes as 
required. A line through a blank section can avoid confusion. 
12.2.1 The 
nature 
of the interview 
The interview differs materially from the traditional consultation in medical 
practice. The aim of the traditional interview is to arrive at a diagnosis and plan 
future medical management of a patient. In the DLA/AA interview, you are 
gathering information that is used to assess the effects of disability on the 
claimant. 
Detailed medical history taking is time wasting and unnecessary. All that is 
required are the essential medical details that impinge on present function. 
12.2.2 Interview 
technique 
It is important that the interview be carried out in a friendly, professional and non-
confrontational way, in keeping with good customer service and in line with 
approved professional standards. 
Guidance for Examining Health Care Professionals 
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Page  50 
 
 

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In the MEC, you should meet the claimant and accompany them from the waiting 
room.  This positive initial point of contact will help put the claimant at ease and is 
a natural courtesy.  From your point of view, it provides an opportunity to observe 
the claimant outside the examination room, and extends the time spent in contact 
with them. Most importantly, it initiates the rapport between the EHCP and 
claimant that is essential to an effective interview. 
The claimant may be apprehensive, and it is good practice to explain the process 
and purpose of the interview and examination. Allow time for the claimant to 
settle down before beginning the interview proper. This is time well spent as it 
allows the interview to proceed more smoothly and productively thereafter.  It is 
also useful to explain that the clinical examination is not in any way a general 
"check up", but is focused on the areas that affect the claimant in their everyday 
life.  This explanation may forestall any criticism that the medical examination 
was not thorough. 
12.2.3 
Claimant accompanied by relative, friend, carer. 
Claimants will often feel more at ease when accompanied, and indeed this may 
be a prerequisite to enable them to come to the Examination Centre. You must 
remain sensitive to the specific situation and comply with the individual’s wishes. 
Companions will be able to give useful information, particularly in cases where 
the claimant has mental health problems, learning difficulties, or communication 
problems, or people who stoically understate their problems. 
Occasionally, a companion may wish to give too forcefully his or her own opinion 
on the claimant’s disability, perhaps giving a biased view.  
You will use your own judgement in weighing the companion's evidence. If the 
companion is too intrusive, then you should point out that the claimant must be 
allowed to express their view. If this strategy is unsuccessful, the companion 
should be asked to leave. 
The actual physical examination is not normally done in the presence of the 
companion, but strictly with the claimant's consent, and if it appears a reasonable 
request, then the companion should be allowed to be present. 
12.2.4 Interpreters 
Where the claimant is not fluent in your language, it will be necessary for the 
claimant to be accompanied by an interpreter. It is important that you make a 
note of the name of the interpreter and the language being interpreted on the 
front page of the report form. 
Under these circumstances the assessment may take longer than usual as 
adequate time will be needed for questions and responses to be interpreted. Do 
not appear to rush or frequently interrupt the process. Be aware of the possibility 
that the interpreter may be expressing his or her own views and conclusions 
rather than those of the claimant. 
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Page  51 
 
 

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If the claimant attends without an interpreter and you cannot continue 
satisfactorily, then the interview should cease and the claimant should be 
requested to attend again with an interpreter. A note of the circumstances should 
be made on the report form.  
Note that a minor (child under 16 years old) is not an appropriate interpreter, and 
alternative arrangements should be made. 
12.2.5 Interview 
skills 
As an essential component of the examination process, the interview requires 
you to possess appropriate skills.   These include: 
 Active  listening 
 Effective  questioning 
 The use of clear and understandable language 
 The use of positive body language 
 Active Listening involves- 
a.  Keeping an open mind and being prepared for all responses to questions 
b.  Summarising what has been said 
c.  Listening "between the lines" 
12.2.5.1 Effective 
questioning 
This is aimed at gaining a mental picture of the claimant in his or her own 
environment and circumstances.  In this way, we obtain an overall view of the 
way in which their disability affects their day-to-day life:- 
 Open questions invite an open response and encourage the claimant to 
provide a narrative answer. 
 Closed questions are best confined to establishing or clarifying a fact, or 
restoring the direction of the interview if the claimant begins to digress. 
 Extending questions enlarge upon an established topic and allow the claimant 
to expand on information already given. 
 Linking questions pick up an earlier point and help to steer the conversation in 
a particular direction. 
 Clarifying questions allow the EHCP to check their understanding of the issues 
being discussed. 
In general, only one question should be asked at a time. Complicated, limited 
response and leading questions should be avoided. 
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Page  52 
 
 

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12.2.5.2 
The use of clear and understandable language   
It is essential that you use language and terms that are clear, familiar and 
comprehensible to the claimant. Otherwise, misunderstandings are inevitable and 
a clear view of the claimant's disability will not be obtained. 
12.2.5.3 
The use of positive body language   
Many EHCPs already possess this skill. However, the interview can involve a 
good deal of writing, and the claimant may feel isolated and excluded as a result. 
It is good practice to minimise the effects of this by interrupting your writing from 
time to time, however briefly, to restore direct contact with the claimant.  
It is also very important to face away from the computer screen at frequent 
intervals, to ensure eye contact is maintained and develop an essential rapport 
with the claimant. 
12.2.6 
Good assessment techniques 
This section provides a practical six-step summary to promote consistent good 
practice in assessing all individuals. (Clearly, some points will only apply in the 
DV setting). 
Step 1: Before the assessment – setting the scene for interview by: 
 
  Following the recommended process for making the appointment  
  
  Allowing the claimant time to arrange for a relative or carer to be present  
 
  Be aware of any background information provided.
 
 
 
  Arriving at the agreed time 
 
Step 2: Structuring the interview - introductions 
 
  Ensure that you take time to introduce yourself to the claimant and carers. 
 
  Establish the identity and roles of those present. 
 
  Check the claimant’s identity against the details provided. 
 

 
  Reduce distractions if possible (e.g. loud TV in the background etc)  
  Ensure the environment is conducive to making a professional assessment 
 
of disability e.g. quiet, well lit and comfortable  
 
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Step 3:  Explanations of why you are there, what you would like to do and 
how you would like to do it. 

 
1.  Explain that your aim is to:  
 
  Provide further information for the DM who is dealing with the claimant’s 
 
case. 
 
  Listen to the individuals needs and carry out an assessment. 
 
  Prepare a report which will help the DM to come to the right decision. 
 
 
 
2.  Explain that you wish to: 
 
 
  Record information focussed on the individuals needs. 
 
 

  Take any information from the carer or relative if required. 
 
  Carry out an appropriate examination. 
 
  Describe what this may involve. 
 
  Emphasise the intention to avoid distress or discomfort. 
 

 
  Give an indication of how long the assessment will take. 
 
  Explain that you will be taking notes. 
 
Step 4: Clarification 
 
  Check if the claimant and carer have any specific concerns about the 
 
assessment etc. 
 
  Establish their feelings and attitudes and try to allay any anxieties. 
 
  Answer any questions about the purpose or format of the assessment. 
 
 
 
 
 
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Step 5: Conducting the assessment – communication 
 

 
  Use good listening techniques. 
 
  Remember eye contact and body language. 
 
  Be patient and show interest in the individual. 
 
  Keep an open mind while obtaining the statement allowing the claimant to 
express their needs etc as fully as possible. 
 
  Be aware of areas of likely sensitivity 
 
  Gain explicit permission to perform a clinical examination. 
 
  Explain what you are about to do step by step throughout the assessment. 
 
Step 6: Ending the assessment – closure 
 
 
  Ask if the claimant or carer has any further questions and respond to 
them appropriately. 
 
  Explain what happens next i.e. that the report and any other relevant 
 
information will go to DM. 
 
 
  Inform them that if they wish to check on the progress of their claim that 
 
they should contact the number provided in the appointment letter. 
 
  Do not discuss the possible outcome of the claim 
 
12.2.7 
Recording the interview 
Details about the claimant will have been entered on the report form by the 
administration staff, and you should check these. 
The time of start of examination is when you first make contact with the claimant.  
The time that the examination ends is when the EHCP or the claimant leaves.  
The time that the form was finally completed should also be added. 
List all the current diagnoses. Ensure that all conditions referred to by the 
claimant and on file are included. Previously unidentified conditions that are 
revealed during the assessment should also be added.  
 
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In many instances the entries will be symptoms rather than exact diagnoses. 
Your role is to assess disability, and for that reason, precise diagnoses do not 
add to the Decision Maker's understanding of the report. Only be specific if you 
have good evidence of the diagnosis. If you write "Lumbar disc protrusion" rather 
than "Low back pain" and it transpires at a Tribunal that investigations revealed 
spondylolisthesis then the whole value of the evidence you have provided for the 
Decision Maker is undermined. 
12.2.7.1 
Details of any hospital treatment or investigations 
Details of any hospital treatment or investigations should be recorded. It is most 
important to keep this information brief, concise and relevant to the present 
disabilities.   Note whether the claimant continues to attend hospital, and the 
likely date of any proposed treatment procedure or investigation; for example "Is 
being admitted for lumbar spine operation within the next 6 weeks"; "Due to have 
a scan in 2 weeks time". 
12.2.7.2 Medication 
Record all regular medication whether prescribed or bought over the counter. 
Record the dose without using shorthand or abbreviations. 
Explain the purpose of the medication, for example: 
 "Beclomethasone inhaler - an inhaled preparation for asthma prevention" 
 "Diclofenac - an anti-inflammatory drug for arthritis."  
It is helpful to comment on any analgesics being taken. This may give an insight 
into the variability of the condition as most people take them when required rather 
than on a regular basis. "He takes an average of 12 paracetamol (painkillers) a 
week, usually over three days" provides a picture for the Decision Maker that will 
support your description of variability and pain later in the report. It is also useful 
to comment on the potency of the analgesic. 
Note any side effects of medication reported by the claimant, the likelihood of 
them occurring and whether these are likely to affect function. For example, it 
would be unlikely that anti-convulsant medication caused such severe 
drowsiness that care needs resulted. Conversely, a marked tremor due to the 
side effects of anti-psychotic drugs, thus affecting self care, is possible. 
Explain any additional medication used to ameliorate side effects e.g. the use of 
lansoprazole in dyspepsia related to the use of NSAIDs.  
12.2.7.3 
Reported impairments and functional restrictions  
You should record an account of the claimant's problems and the functional 
limitations imposed by them e.g. "Variable pains in both elbows which restrict 
his/her ability to lift a saucepan or kettle" and “Suffers with anxiety which prevents 
him/her from going out alone”. 
It is also important to record the response of the claimant to his or her current 
treatment. 
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Most important is an outline of how a typical day is spent in the light of the 
reported limitations. 

12.2.7.4 The 
typical 
day 
Although not always easy to elicit, a careful and well-focused history of a typical 
day will greatly help you in completing the rest of the report.  If you obtain and 
record appropriate information at this stage, it will provide you with factual 
evidence of the claimant's abilities, which you can then use to support your 
opinions.  
Note that the phrase ‘typical day’ refers to the 24 hours in a day i.e. it 
includes night-time. 

You must write this section in the third person. It is a record of the claimant's 
everyday life, without interpretation by the medical examiner.  You should make it 
clear that this is the claimant's account of their disabilities and not your opinion.  If 
someone else gives information on the claimant’s behalf (e.g. a parent on behalf 
of their child), then this should be noted. 
It is a factual description of how the claimant's condition affects them in day-to-
day life as elicited by careful interview, using the recommended techniques 
referred to in this handbook. Properly completed, it is of great help to the decision 
maker. 
The account of the ‘typical day’ should provide the DM with information regarding 
the following: 
 Getting  up 
 Washing,  dressing 
 Using the toilet and continence 
 Help with medication and other treatments 
 Rising from a chair 
 Preparation of food and eating 
 Going to bed 
 Help needed during the night e.g. toilet and medication 
 Ability to walk indoors and outdoors 
 Ability to use a wheelchair if required 
 The nature of any falls and if they occur indoors or outdoors 
 Need for supervision e.g. to avoid dangers or self neglect 
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 Getting around outdoors (including any supervision required) 
 Role of carers (including the help required and the functional problem they 
overcome e.g. “The claimant cannot bend to their feet, therefore their carer 
ties their shoe laces.”) 
 Communicating with others (including interpretation of sign language, help when 
visiting people or places, special equipment e.g. writing pad, telephone, 
special computer etc) 
 The effects of the disability present upon hobbies, interests, leisure pursuits and 
activities connected with religious beliefs 
It is useful to focus on areas of activity affected by any disabling conditions. For 
example in cases of low back pain, bear in mind activities which involve sitting, 
rising from a chair, walking, using stairs, bending and standing.  
You should give specific examples of activities, e.g. "Has no problems filling and 
emptying the washing machine or tumble dryer".   
Also, avoid making a statement such as "Can only walk 50 metres" as this may 
well be taken as fact by the Decision Maker or the Appeal Tribunal. Better would 
be; "Says he only walks 50 metres", then give an example of what the claimant 
actually does, as far as walking is concerned, on an average day: "Walks to the 
shops and back (about 200 metres in all) but says he has to stop at least twice 
due to back pain". 
12.2.8 
Examinations carried out in the MEC 
The process of carrying out the assessment in the MEC is little different from that 
carried out in the domiciliary setting, with one important exception. You will be 
unable to assess the claimant’s home surroundings and their ability to function in 
that environment. 
To make up for this you will need to take a careful history from the claimant about 
the difficulties of managing within the home, aids used etc.  
Areas for focus would be whether there are any stairs inside or leading up to the 
home, if toilet facilities are on the same level as the main living area, if there is a 
shower or a bath etc.  
If you consider a commode would enable the person to be self-caring for toilet 
needs, then obtain details of whether it could be sited in the relevant room, e.g. is 
there enough space for a commode? 
When looking for evidence of self-neglect it will be more important to record a 
pen picture of how the claimant appears to you on the day of assessment, in 
terms of personal hygiene and nutritional status.  
The opportunities to observe the claimant’s gait, balance and mobility are likely to 
be greater in the MEC setting compared to a DV. 
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12.2.9 Additional 
information 
In exceptional circumstances, you may feel that additional clinical information is 
required.  In such situations then you should seek the advice of a Registered 
Medical Practitioner at your local Atos Healthcare Centre e.g. if there is no carer 
or relative present and there are major difficulties with communication. 
12.3  Physical examination in EHCP assessments 
You should seek the claimant's express permission before proceeding to carry 
out any physical examination that you deem to be necessary.  It is vitally 
important to understand that consent is not assumed.   
Explicit consent to the examination and its different parts must be obtained 
verbally from the claimant, and the fact that this has been done should be noted 
in the report.  A suitable form of words would be along the lines of, "The details of 
the physical examination were explained to the claimant, who gave consent for 
the process to proceed."  
The precise extent and nature of the examination will depend entirely on the 
circumstances of each individual case.  You must use your professional 
judgement to decide what examination is indicated, and whether the claimant 
should be asked to remove any clothing in order to complete this assessment 
effectively.  
When carrying out a musculoskeletal overview examination, you should usually 
be able to complete this aspect of the assessment whilst the claimant is wearing 
loose indoor clothing, if you are checking to confirm normality.   
If you suspect an abnormality, and thus are led towards a regional inspection and 
examination, it would be usual for you to ask the claimant to remove the relevant 
items of outer clothing in order to complete this task.   
If your actions were ever queried, you should be able to justify anything that you 
have asked the claimant to do, with regard to undressing and their participation in 
the examination process.  Similarly, you should be able to justify any omissions 
that you have deliberately made in these areas, particularly if these might be 
considered to deviate from usual disability assessment practice. 
As the assessment proceeds, explain any request you make of the claimant 
to remove clothing, and explain every step of the examination process, so 
that there can be no misunderstanding about movements they are asked to 
perform or clinical tests you are carrying out.  

Virtually all movements should be active and not passive. Only ask 
claimants to demonstrate activities within their own limits.   

It will never be necessary to ask a claimant to remove items of intimate 
underwear or to carry out intimate examinations (that is examinations of the 
breasts, genitalia or rectum) as part of a disability functional assessment.   
 
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Please note also that use of needles is not appropriate in the context of disability 
assessment medicine, and thus the testing of pinprick sensation should not be 
undertaken.  
When carrying out a physical examination, you should use your professional 
judgement to decide when it is appropriate to offer a chaperone, or to invite the 
claimant to have a relative or friend present.  In this context, the duty of the 
chaperone is to protect you from any potential complaints about unethical 
conduct, and the chaperone’s role is merely to remain in the room whilst you 
examine the claimant, unless you ask the chaperone for assistance.  This 
guidance assumes particular significance when the EHCP and claimant are not of 
the same gender. 
If a chaperone, relative or friend is present, you should record the fact on the 
report form, making a note of the person’s identity.  In the MEC, one of the MEAs 
can act as a chaperone if required. 
If the claimant does not want a chaperone, you should record that the offer was 
made and declined. 
Give the claimant privacy to undress and dress.  Do not assist the claimant in 
removing clothing unless you have clarified with them that your assistance is 
required. 
When recording the relevant findings of your assessment, in some situations it 
will be important to note normal findings e.g. normal reflexes and muscle tone.  In 
others, recording inappropriate findings may be required. Sufficient detail should 
be included, with measurements in metric units (imperial units can be used as 
supplementary indications). 
12.3.1 
Examination of vision 
If the claimant wears spectacles, they must be worn when testing visual acuity.  It 
is important to assess vision for its usefulness outdoors and to consider the 
acuity over the whole visual field.  A Snellen's chart or similar should be used for 
distance vision, and a standardised reading test chart for near vision.  
12.3.2 
Examination of hearing 
If the claimant wears a hearing aid, it must be worn when assessing hearing.  It is 
important to test the claimant's understanding, not just their ability to react to 
sound.  The test should take the form of a simple instruction or question, shouted 
if necessary, from one metre behind the claimant. 
Take into account background noise when assessing the usefulness of the 
hearing out of doors. 
If there is any indication of hearing loss, the ears must be examined and any 
pathology or obstruction noted. 
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12.3.3 
Examination of peak flow 
The Wright-McKerrow scale, used on hand held mini-peak flow meters, is less 
accurate at the high and low ends of its range. Therefore asthma may be under-
diagnosed and treatment suboptimal. 
A new EU standard was introduced in 2004 for all new mini peak flow meters (EN 
13826).  
The difference between the two scales is not likely to affect assessment of 
function. 
A well maintained, good condition peak flow meter can still be used. An algorithm 
can be used to convert the old scale to the EU standard (available at 
www.peakflow.com).  
The conversion does not have to be done by the EHCP. However, when 
documenting peak-flow, record whether a “Wright” or “EU” meter was used e.g. 
PFR 450 l/min (Wright) or PFR 450 l/min (EU). 
12.4  Mental state examination 
It is important to provide information about the claimant’s mental state in the 
appropriate part of the report form. This may be to confirm that the individual’s 
mental state is normal. However, the reasons for your opinion must be recorded 
with reference to mood, appearance, thought processes, speech etc. 
Any evidence of mental illness should be recorded. If the claimant appears to be 
confused or has an altered perception of their condition it is strongly advised you 
seek additional information from a relative or carer.  Where this additional 
information is not available in the examination setting then you should provide as 
much detailed information as you can to the DM. 
12.5 Your 
opinion 
You must form your own opinion, considering the history, observations, 
examination and any other evidence available, on whether the reported 
limitations are reasonable. 
If your opinion of the claimant's capabilities differs from their own, it is very 
important that you record your opinion and sufficient additional information with 
adequate clinical details to make it clear why you have come to a different 
conclusion. 
Internal consistency of the report is important for the DM.  If the EHCP expresses 
a reduction in function there should be evidence that justifies that opinion e.g. 
particular clinical findings.  
Record details of any aids used by the claimant, which reduce the need for help.  
You do not need to report on aids a claimant could, but does not use, unless it is 
clear that the claimant is not using an aid which: 
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 In your opinion, they are able to use; 
 Is readily available; and 
 Many others in their situation use. 
In these circumstances record the basis for your opinion, including: 
 Full details of why the aid is appropriate. 
 How the aid would help. 
 How easily the claimant could obtain the aid. 
 The claimant's reasons for not using the aid. 
 A description of the claimant's home circumstances if necessary. 
 
Key point 
 
Your opinion on the person’s capabilities should take into account the use of all 
appropriate aids and appliances, even if they are not in fact used by the claimant 
 
but which could be readily available to them. 
 
When giving your opinion regarding falls, the risk of falling also needs to be 
considered. A claimant does not have to have a history of falls for an EHCP to 
form a medical opinion that they are at risk. This is particularly true in Attendance 
Allowance. 
12.6  The assessment of mobility 
Your opinion on the claimant's walking ability must be consistent with your clinical 
findings, informal observations and your assessment of the stage of their illness. 
This takes into account the level of investigation and treatment and the likely 
effects of the condition on a person of that age, but is not based on a formal 
walking test.  It is likely that the claimant’s walking ability will be observed 
informally at home or in the MEC. In the DV scenario, the claimant’s functional 
ability on stairs may be seen. 
If the claimant is not seen to walk, the assessment of walking ability is made 
based on: 
 Observation of limb, spinal and cardio-respiratory function. 
 Your clinical findings in relation to lower limb function and musculature, co-
ordination, balance and cardio-respiratory status. 
Your opinion considers the claimant’s walking distance outdoors on level ground, 
before the onset of severe discomfort. 
 
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People’s estimates of distance and time tend to be inaccurate.  However they can 
usually say where they walk to e.g. the local shops, bus stop etc.  You may know 
how far this is from local knowledge.  
Generally speaking, a person who can easily manage around the house and 
garden is unlikely to be limited to a walking distance of less than 200 metres. 
Similarly, a person who can walk around a large supermarket is unlikely to be 
limited to less than 800 metres. 
 
Key points for assessing walking ability 
 

 
  Someone walking at an average speed manages about 61 - 90 metres in 
one minute (i.e. up to the length of a football field). 
 
  Walking at a slow speed equates to 40 - 60 metres in one minute. 
 
  Walking at a very slow speed equates to less than 40 metres a minute 
 
 
In very rare circumstances, it may be necessary to ask the person to undertake a 
walking test.  However, it is not recommended as it is of limited value and may 
cause distress. This should be adapted to meet the individual circumstances but 
ideally should involve asking the person to walk outdoors, on level ground at their 
normal pace, for 2 minutes.  The accuracy of observations recorded during the 
test is important and special note should be taken of a deviation from the normal. 
Data should include the distance walked, the time taken, and any change in 
pulse rate during the test.  These factors should be accompanied by qualitative 
observations on gait, balance, manner of progress, along with an estimate of the 
level of pain or discomfort experienced.  The number, duration and nature of any 
pauses should also be recorded. 
Take the use of a walking stick or any other support into account.  If the claimant 
has had an amputation, consider the use of any prostheses that have been 
supplied. If not supplied, the prostheses the claimant would be capable of using 
to improve their walking ability. 
It is important to differentiate between guidance from another person and the 
physical support of another person.  If the claimant can only walk with the support 
of another person, this does not constitute walking.  In this situation, give your 
opinion on the claimant's independent walking ability.   
If a person's walking ability varies, take account of the overall ability over a period 
of time not just their ability on the day of the examination. When walking is 
interrupted by sudden stops, describe the nature and frequency of the 
interruptions.   
It is important to differentiate between stops that are of the person's own making 
and stops that are due to a physical condition for which a rest is justifiable. 
When a person is able to walk but needs a companion when outdoors, it is 
important to record precisely what active help is needed due to a physical or 
mental disability, e.g. guidance, encouragement or persuasion. 
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12.7  The assessment of care needs 
12.7.1 Attention 
needs 
In section three of the report form you will provide your opinion regarding any 
attention needs. It is important to fully justify your opinions, particularly if you 
disagree with the claimant or other evidence on file. Your opinion should take into 
account: 
 The claimant’s stated needs 
 Observed  findings 
 Examination  findings 
 Any other information that may be on file. 
Also, the use of aids needs to be considered.  Examples that may be appropriate 
are: 
 A urine bottle  
 A  commode 
 Special cutlery and crockery 
 Walking sticks, crutches 
 Bath aids – grips, seat/stool, step, lifts 
 Shower aids - seat, wheelchair access etc 
 Toilet aids – grips, raised seats, frame 
 A monkey pole over the bed, grips etc 
 Height of bed 
 Design and height of normal seat 
 Kitchen aids – adapted openers, spikes 
 Dressing aids - helping hand etc. 
The above list is not comprehensive.  
Your report must show if the claimant could use these aids but personal 
circumstances prevent it.  If it would be unreasonable for the claimant to change 
their circumstances to accommodate the use of aids, discount their potential use. 
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12.7.2 
Care at Night 
Accuracy in obtaining and assessing needs at night is vitally important, especially 
regarding the frequency and/or length of time help is needed.  It may be quite 
straightforward to obtain this information when the same needs arise every day or 
night.  However, the need for help will be intermittent for many people, especially 
at night. 
It is realised that night needs can be particularly difficult to assess accurately, but 
your assessment must be consistent with your clinical findings and your 
professional knowledge of the needs likely to arise from the identified disability or 
disabilities.  
The DM requires an opinion regarding the need for help at night from the 
available evidence. 
If a need is present in your opinion, always explain why it is the same as, or 
different from, that described by the claimant, in type, frequency and/or amount. 
When providing your opinion, it does not include time spent providing comfort or 
companionship. 
Note that elderly people often understate rather than exaggerate any disability 
present. 
12.7.3 Supervision 
Needs 
When giving your opinion on the need for supervision, consider if reasonable, 
common sense precautions could be taken to prevent danger arising.  Such 
precautions should be: 
 Practicable 
 Available 
 Affordable 
For example, securing doors and windows and fitting a stair-gate might reduce 
the risk of injury to a child with learning difficulties. However, the household will 
still need to go about its business in a reasonable manner.  The modifications 
should take account of this.  In addition, any such modification must not infringe 
on the individual’s personal freedom. 
Determine if dangerous situations have occurred in the past and if they are likely 
to happen in the future.  This includes situations that may be dangerous to other 
people as well as the claimant.  It is important to describe details of past 
dangerous situations if possible from a knowledgeable third party (e.g. carer) so 
that future risk can be assessed. 
Even if there have not been any problems in the past, still give your opinion on 
the likelihood of future dangerous situations.   
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12.8 Epilepsy 
Questionnaire 
This should be completed in full if there is any suggestion of seizure activity. 
Blackouts, dizzy spells, funny turns and panic attacks should be addressed 
clearly elsewhere in the report for the Decision Maker.  
For example, in any insulin dependant diabetic there should always be a clear 
description about whether hypoglycaemic episodes occur. If they do, record 
whether there is a warning, how often they occur, what help is needed from 
another etc. Although the associated altered consciousness is not dealt with in 
the Epilepsy Questionnaire, it should be covered in detail through main part of 
the report. 
It would be very unusual for a person with epilepsy of several years duration to 
not have seen a specialist and had investigations.  
Status epilepticus is a life threatening condition which always results in hospital 
admission. 
12.9 Functional 
prognosis 
The likely prognosis of current functional problems and conditions should be 
provided for the DM.  This should include, where relevant, the expected effects of 
any known planned treatment.  
12.10 Variability of conditions 
It is important to provide as much information as possible regarding the nature 
and extent of any variability in function. 
A severely disabled person is entitled to DLA or AA for a period throughout 
which 
they satisfy, or are likely to satisfy, the conditions of entitlement to the 
benefits (The Social Security Contributions and Benefits Act 1992).  ‘A period 
throughout which’ is one throughout which the conditions of entitlement usually 
are, or likely to be, satisfied on more days and/or nights of the week than not. 
In practice, until a Court of Appeal judgement in 2002, DLA or AA would not be 
awarded in most cases unless the conditions of entitlement were met on 4 days 
and/or nights of the week or more. The Court of Appeal held that the ‘period 
throughout which’ test could be satisfied on as little as one day (or night) a week 
providing this need arises on a regular basis. 
In the House of Lords ruling on this case, of July 31st 2003, Lord Hoffman stated 
that the decision should be based on consideration of the whole period, 
identifying whether in a general sense the person can fairly be described as a 
person who is unable, as a result of disability, to carry out the specific tasks of 
self care and day to day living. This is an exercise in judgement rather than an 
arithmetical calculation of frequency. 
When completing the report form, you should record the frequency of good and 
bad days, as well as if the assessment was carried out on a good or a bad day. 
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As an EHCP, you need to be aware of the need to advise the DM on the 
variability of the care/mobility needs of the claimant.  On all EHCP reports, you 
must ensure that you record your own opinion about variation in disability, and 
consequently on function, from day to day. 
Where a client describes variability in their condition and/or its effects on function, 
or where the EHCP identifies a variable/intermittent condition or where the DM 
requests information about variability, EHCPs should: 
 Advise on the level or care/mobility needs for the majority of the time 
And 
 Give an indication of the claimant’s condition on bad days together with: 
a)  The frequency of the bad days 
b)  Advice regarding whether the bad days follow a regular or predictable 
pattern 
c)  The care/mobility needs on a bad day 
It is important to appreciate that, in addition to recording the claimant’s reported 
variability, you are being asked to express your opinion about the level of 
variation that you would expect to take place, given the circumstances of the 
case under consideration.  In so doing, it is important to recognise that the 
variation that a claimant reports in their level of symptoms will not necessarily 
translate into a significant variability in their level of function.  
Your advice must be based on what is medically reasonable in that case, and 
must be adequately justified. This last statement is, of course, true for all the 
advice that you give in all your reports. 
When completing the report form, it is important to note: 
 In Section 1 of the report form, the claimant’s description of any variability is 
recorded.  
 In Section 3 of the report form, the EHCP records their fully justified opinion 
regarding any variability of all conditions identified. 
 If a condition does not (or is not likely to) vary in its disabling effects, it is 
important to record this for the DM in Section 3 (e.g. the disabling effects of a 
below-knee amputation performed 10 years ago, considered in isolation, 
would not be expected to vary). 
 
 
 
 
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Examples 
The following examples illustrate the salient points 
1)  A claimant with mechanical back pain reports that the symptoms are worse on 
1 to 2 days every 1 to 2 weeks. The EHCP would usually conclude that the 
level of function should not vary significantly even though the pain may be 
worse on some days. The medical basis for this opinion is that mechanical 
back pain does not cause substantial fluctuations in function over this type of 
time scale. The EHCP might possibly also refer to the general advice that 
people with back pain should usually try to keep mobile. 
2)  A claimant with mechanical back pain tells the EHCP that in addition to the 
level of pain and functional problems that they usually experience, there are 
occasional exacerbations of back pain when mobility is severely limited for 
three or four days. These episodes occur irregularly and infrequently; there 
have been two of these episodes in the last one and a half years. The EHCP 
would mention this in the account and state that this is consistent with the 
natural history of back pain. However, in this situation, the EHCP would not 
need to describe in detail the level of functional problems during these 
exacerbations, as the claimed variability is irregular and infrequent. 
3)  A claimant with multiple diagnoses e.g. ischaemic heart disease, type 2 
diabetes mellitus and generalised joint disease may be seen on an average 
day. However, they may claim that they need more help getting out of bed and 
with self-care on a bad day. They may also state that they do not go out on 
bad days because of joint pains. If observation and musculoskeletal 
examination by the EHCP are all normal, or if they only demonstrate minor 
functional deficit, the EHCP should say that significant variation in function is 
unlikely in the absence of physical signs indicating significant joint disease. 
4)  A claimant with proven ischaemic heart disease might say that their angina is 
worse when walking outdoors when the weather is cold or windy. The EHCP 
may well agree that this would be an aggravating factor. However, the 
frequency is quite unpredictable, as it is weather related. 
5)  A claimant with episodes of migraine reports they have acute episodes once 
or twice a week during which they are prostrated for a short period of time. 
There is supportive evidence for this, in that the claimant is taking prophylactic 
treatment in addition to treatment for acute attacks. They are also attending 
their GP regularly as well as a neurology outpatient clinic. In such 
circumstances, the EHCP may conclude that the claimed variability in function 
is reasonable, as it follows a medically recognisable pattern with the condition 
and is consistent with the medical management being provided. However, a 
different conclusion may have been drawn if the collateral evidence, indicative 
of more severe disability, had been absent i.e. if medical management had 
been less active. 
 
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12.11  Unexpected findings (see Appendix E) 
It is your responsibility to report any serious abnormality that is detected, e.g. a 
significantly raised blood pressure in someone not diagnosed as hypertensive, to 
the claimant's GP by telephone and in writing. 
Appendix E contains procedural guidance for all examining EHCPs on this 
important topic that you should refer to. 
12.12  Harmful, embarrassing and confidential information 
Anyone who claims DLA or AA is entitled to see all the evidence used to decide 
his or her claim. Information contained in a document that has been used to 
reach a decision cannot be withheld from the claimant unless it is harmful. 
The distinction between this and other forms of sensitive information i.e. what is 
embarrassing or confidential, should be clearly understood. 
12.12.1 Harmful 
information 
Harmful information is information of which claimants are unaware, and which 
would be seriously harmful to their health if divulged to them. 
The EHCP will encounter such information in one of three possible ways.  It may 
arise: 
 From a third party source, for example a relative or carer, or 
 In the form of a factual report offered by a relative, the contents of which are 
unknown to the claimant, or 
 In the form of unexpected abnormal clinical findings which suggest a serious, 
life-threatening condition. 
 
In the first instance above, the EHCP should write down the information on a 
separate piece of paper, headed “Harmful Information”, include the claimant’s 
name and NINO and ask the person providing the information to sign the paper. 
In the second instance, the evidence should be accepted, marked “Harmful 
Information” and placed in the file.  
If the unexpected findings should be regarded as harmful information; that is, if 
they imply some previously undiagnosed life-threatening disorder of which the 
claimant is unaware, there is no need to write down the putative diagnosis on the 
UE1 (Rev). You should confine yourself to an account of the clinical findings.  
Discussions with the claimant would need to reflect the sensitivities of the 
situation.  
If harmful information is identified in the course of file work, it should be 
annotated as such, making the DM is aware of this fact. 
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12.12.2 Embarrassing 
information 
Information that may be embarrassing to the claimant, carer or professional 
colleague but is not harmful cannot be excluded from copies of documents sent 
to the claimant.  Do not record information of this type in reports.  Examples 
include: 
 Criticism of the diagnosis of the claimant’s condition, or of their medical care and 
treatment. 
 Criticism of an EHCP who examined the claimant on a previous occasion. 
It is especially important to be aware of mentioning convictions or prison 
sentences with regard to the Rehabilitation of Offenders Act, 1974 (see section 
9.4). 
Before a decision is reached on a claim, the author of the embarrassing 
information should be contacted to see if they would like to rephrase their report. 
However, if a decision has already been made with this information available to 
the DM, it must remain on file and must be copied to the client where necessary. 
12.12.3 Confidential 
information 
Any letter or report that is headed “Confidential” or “In Confidence” should not be 
generally disclosed.  The DM cannot use this information. The information can be 
used however if the author of the letter is prepared to remove the confidentiality 
statement. The holder of the information should approach the author. 
Do not record any information under this heading on your report.  
If the claimant gives the EHCP information, but asks for it not to be recorded, 
they should be informed that it cannot form part of the decision making process. 
12.13  Personal descriptions in medical reports 
12.13.1 General 
principles 
The following general principles must always be observed: 
 
  The description must be relevant to the matters that are under 
 
consideration in the report and its inclusion should add value to the report. 
 
  If the relevance may not be immediately obvious to all the persons who 
are liable to read the report, it must be fully explained. 
 
 
  The description must be phrased in terms that will not cause offence. 
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12.13.2 Descriptions 
of 
race or ethnic origin 
The process of Disability Analysis requires EHCPs to consider specifically the 
manner in which disability affects the individual whose case is being assessed.  
Within this process, the focus must rest clearly on what the person can and 
cannot do because of their underlying condition. A person’s race or ethnic origin 
will almost never prove relevant to such considerations.  
Consequently, in the context of the examinations that are conducted on behalf of 
customers of Atos Healthcare, references to racial origin are almost universally 
unnecessary, and the inappropriate use of such descriptions is liable to cause 
offence. In addition, the use of inappropriate descriptions may, in certain 
circumstances, lead to an action being brought against the author under the 
Race Relations Act 1976 or the Sex Discrimination Act 1975. 
 It follows that a description of race or ethnic origin should only be incorporated in 
a report where there are overriding and compelling medical reasons for including 
such information.  If you consider that a description of race or ethnic origin is 
essential, the reason for its inclusion should be made explicit and the description 
used should be factual and expressed as categorised in the Census, as follows: 
 White 
 Black – African 
 Black – Caribbean 
 Black – Other (please specify) 
 Indian 
 Pakistani 
 Bangladeshi 
 Chinese 
 Other (please specify) 
These categories do not cover all situations, e.g. those of mixed race.   
Descriptions of race or ethnic origin must not be confused with details of 
nationality, citizenship or place of birth, and it is not anticipated that any 
circumstances will arise where references to such matters could be considered 
appropriate.   
If during the assessment you know that you will be recording a description of race 
or ethnic origin, it is advisable to explain why and to check it with the claimant or 
representative to ensure accuracy. 
 
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12.13.3 
Descriptions of personal appearance 
References to personal appearance are not infrequently made in reports 
prepared for the DWP.  You should appreciate that there is no place for 
gratuitous comments.  Personal appearance should not be described unless 
there is a clear and unambiguous reason for doing so.  The linkage between any 
reference to personal appearance and the functional assessment must be made 
explicit. Information that adds no value to the report should be omitted altogether 
e.g. comments concerning simple obesity with no related disability, length of hair, 
tattoos, body piercing etc. 
Where obesity is contributing to or exacerbating disability, this fact should be 
mentioned.  It is better to avoid the word ‘obesity’, even though it is medically 
defined. It is preferable to refer to the Body Mass Index, with a suitable 
explanation, or to use the term ‘overweight’.  
You must avoid drawing unwarranted inferences from a person’s clothing, style of 
dress, make-up, jewellery or general appearance, and you should avoid 
commenting on such matters unless the observations form an integral part of the 
medical evidence.  For example, a description of a person as ‘untidy and 
unkempt’ may provide useful information to support an assessment of someone 
with cognitive impairment, learning disability, etc., or it may illustrate a particular 
degree of functional limitation. 
Comments that convey a positive impression of the claimant’s appearance, such 
as ‘neatly dressed’, may add useful information in those cases where the 
individual’s ability to care for their appearance forms a relevant part of the 
assessment.  However, you must take into account such factors as help provided 
by another person or the degree of difficulty experienced by the individual in 
attaining their appearance.  The effects of a fluctuating disorder on an individual’s 
day-to-day ability to dress and present themselves must also be considered.  
Exercise caution in drawing inferences from isolated observations.  Adhere to the 
principles of disability analysis and consider any information derived from the 
person’s personal appearance in conjunction with all other relevant evidence 
before drawing any conclusions. 
The circumstances of the case will often dictate whether or not the inclusion of 
certain information is relevant.  For example, a comment on the fact that a 
claimant was wearing nail varnish on her toenails would not normally be merited.   
However, this situation would be altered if the claimant’s disability were related to 
a back condition.  
 In such a case it would be appropriate to include this information as justification 
of the advice given in relation to activities that require bending, provided that it 
was ascertained and recorded that she had applied the varnish without 
assistance from another person. 
 
 
 
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12.13.4 
Descriptions of attitude and mood 
The attitude of the person to the assessment process should only be commented 
upon if it has affected your ability to conduct the examination in a normal manner, 
or if uncooperative behaviour occurs that is attributable to the claimant’s medical 
condition.  In such cases, full factual details should be provided. 
It follows that it is appropriate to include details in the report in cases where the 
claimant smelled of alcohol or was intoxicated because of substance abuse 
(including alcohol). 
There are two sets of circumstances where you should terminate an assessment 
without attempting completion, as follows: 
 The behaviour of the claimant poses a threat to you, or to others present. 
 Persistent uncooperative behaviour by the claimant. 
Where such circumstances occur, full details need to be documented. 
When carrying out an assessment of a claimant’s mental health, it is normally 
entirely appropriate and relevant to comment upon such characteristics as mood, 
features of anxiety, and interpersonal skills.   
12.13.5 Practical 
application for EHCP assessments 
An appropriate general clinical appearance of the claimant should be recorded in 
Section 2 of the report form. Descriptions can give the DM a mental picture of the 
claimant and makes it easier for them to interpret the rest of your report.   
Some examples include: 
 “A frail elderly lady who needed three attempts to get out of her chair”. 
Or 
 “A large and very strong 10 year old who constantly demands attention and has 
no appreciation of household dangers”. 
12.14  The assessment of Chronic Fatigue Syndrome (CFS) 
12.14.1 
CFS – clinical features 
CFS, ME and fibromyalgia form part of a continuum of disorders, which share 
common features that may include any or all of: 
 Unexplained fatigue often made worse by physical exertion. 
 Muscle  pain. 
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 Sleep  disturbance. 
 Disturbance of mental functioning: poor concentration, poor short-term memory, 
depression. 
Symptoms of CFS are predominantly subjective. There are various sets of 
diagnostic criteria, such as the Fukuda Criteria, but none of them is definitive. All 
were developed for research, rather than clinical, purposes. There are rarely any 
positive clinical findings on examination. 
There is still debate in medical circles about the aetiology and pathophysiology of 
CFS, neither of which is yet clearly understood. Nevertheless, assessment of the 
functional impact of CFS on a person’s life can be made without full 
understanding of the underlying condition. 
12.14.2 
Medical assessment for benefit purposes 
Despite clear recognition by both the Department of Health and the DWP that 
CFS is a real and disabling condition, some EHCPs still display varying degrees 
of scepticism. Such scepticism is not in keeping with Atos Healthcare 
Professional Standards, and it is not acceptable when EHCPs are carrying out 
assessments on behalf of the DWP. 
People with CFS may have encountered such scepticism among treating 
clinicians, and may as a result adopt a defensive attitude. It is important for you to 
help them understand you are open-minded, prepared to listen to them, and you 
will complete a fair and objective report. 
When assessing a benefit claimant, remember that you must always take careful 
account of the effects of fatigue, of variability of symptoms, and of the ability to 
reasonably sustain any given activity, not just the ability to perform it once. 
Remember that you must carefully evaluate all the evidence, and especially 
whether the person’s description of their disability is consistent with their daily 
activities and lifestyle. This aspect is particularly important when assessing a 
condition, such as CFS, where there are usually few if any overt clinical findings. 
Because of the possible effects on mental functioning of CFS, it will almost 
always be appropriate to assess the claimant’s mental state. People may express 
concern or resentment at this, and may accuse you of believing “it’s all in their 
mind”. You need to help people understand that this does not mean you believe 
the condition is “all in their mind”, but that it is important for you to get a full 
picture of its functional effects, mental/psychological, as well as physical. You 
may find it helpful to give an explanation such as “I’m going to ask you some 
questions to help me understand how your condition affects your memory, mood, 
and concentration”. 
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13.  Risk management for the EHCP 
13.1 Potentially 
aggressive 
situations 
As with every branch of clinical medicine, situations arise when the consultation 
runs into difficulties. Such situations can arise from a variety of reasons including 
claimant anxieties and fears as well as through the direct consequences of their 
clinical conditions.   Clearly, EHCPs do not have a prior understanding of the 
claimants concerns, personality and background. 
The most important factors are the EHCP’s own: 
 Awareness of the possibility of difficulties. 
 Early anticipation and detection of problems that the consultation may be 
running into problems. 
 Ability to adjust and adapt the style or conduct of the consultation. 
From your clinical experience, you will already be familiar with the use of varying 
interview and communication techniques to manage the consultation process 
using verbal and non-verbal approaches. 
The following are some points to remember: 
 Always treat everyone impartially and sympathetically, and be seen to do so. 
 Some claimants use bad language and gestures as a normal means of 
communication.  Nobody, however, is expected to suffer severe abuse, 
especially if it is sexual or racial in nature.  If you suffer such verbal abuse, tell 
the claimant that the assessment will be terminated if the abuse does not 
cease immediately and record the information on form IF1. 
 Spend time explaining and reassuring the claimant and exploring potential areas 
of concerns and anxieties. 
 Be friendly but firm. 
 Be seen to be in control of the situation, in a pleasant manner. 
 Never retaliate by word or deed even if provoked, and remain calm. 
 Do not continue in the face of persistent abuse or aggression.  
 Observe exits as you arrive, and remain between the exit and the claimant. 
Good practice points are dealt with in more detail earlier in this guidance.    
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Key Points to minimise the risk. 
EMPs should: 
 Preview 
the 
papers. 
  Note anyone identified as a potentially violent claimant by the DBC.  
  Use any local knowledge of people or addresses which pose greater risk. 
 
All serious incidents involving a member of the public should be reported using 
the procedures described below.   
Such incidents include: 
 Severe or persistent verbal abuse. 
 Assault of whatever degree. 
 Serious  threats. 
 Intimidation. 
 Serious or persistent harassment. 
This applies whether the person committing the act is the claimant, their relative 
or a member of their household and whether it occurs before, during or after the 
assessment. 
If you believe a visit may be risky, you can take another person as an escort.  
You should have a local contact with the allocation section to arrange an escort if 
you need one.  
If you are ever subjected to abuse or violence then you should report the incident 
as soon as possible to Atos Healthcare.  Form IF1 should be completed for every 
incident.  It may also be advisable to inform the police.  If you need help or advice 
about such incidents, and to obtain the forms, then your local Atos Healthcare 
contact will be pleased to assist.  
13.2  Audio or video taping of examinations 
The DWP never requires that a medical assessment for advising on entitlement 
to state sickness or disability benefits be recorded on audio or videotape. Any 
requests by claimants to tape an examination should not be directly refused, but 
our policy in these circumstances should be fully explained to them. 
Claimants may request that their interview and assessment by an EHCP in 
respect of a benefit claim be recorded either on audio or videotape. 
 
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Such a request can only be agreed with the prior consent of the EHCP, and then 
only if stringent safeguards are in place to ensure that the recording is complete, 
accurate and that the facility is available for simultaneous copies to be made 
available to all parties present.  The recording must be made by a professional 
operator, on equipment of a high standard, properly calibrated by a qualified 
engineer immediately prior to the recording being made.  The equipment must 
have facility for reproduction so that all parties can retain a copy of the tape. 
The responsibility for meeting the cost of the above requirement rests with the 
claimant. 
Any request by a claimant for an assessment to be audio or videotaped must be 
declined unless the above safeguards are in place.  The claimant must instead 
be offered the opportunity of a rescheduled assessment in the presence of a 
companion or other witness.  If the claimant refuses to avail him/her self of this 
opportunity and refuses to proceed with the assessment, the EHCP should return 
the file to the DWP with a note explaining the situation. 
13.2.1 Unauthorised 
Taping 
It is for Atos Healthcare, in conjunction with their legal advisers, to determine the 
action to be taken in the event of a claimant making an audio or video recording 
without the prior knowledge and consent of the EHCP, or without ensuring that 
the safeguards defined above are in place. 
13.3  Taking of notes during an examination by the claimant or 
their companion 
From time to time you may encounter a situation where the claimant is 
accompanied by a companion and either the claimant or companion may wish to 
take notes during the assessment. 
Persons who are entitled to be in attendance are always entitled to take notes.  
This is because it is for their own purposes and not an official record of the 
process. 
To attempt to deny the right to do so is likely to be contrary to Human Rights 
legislation. 
To request a copy of the notes is unlikely to be helpful – it will place you in the 
position where you will be obliged to review the notes and comment on their 
reliability.  However, you should record in the medical report, the fact that notes 
were being taken.  The warning below should also be given and the fact 
documented in the report.  LiMA offers the phrases as an optional addition.  For 
any handwritten report, on the rare occasions when this is necessary, the report 
should be annotated on the front cover. 
“Where notes are taken by you, we consider it of assistance to both myself, as the 
examining Health Care Professional, and yourself to point out the following: 
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 1. It is your right to take notes for your own use and benefit.  
 2. The notes will not be included in the Report I make save for the fact that notes 
were taken and further, they are not accepted by myself or the DWP as an 
official record of this examination. 
 3.   If the notes are subsequently produced at any time for any purpose, such as 
part of an appeal process, I the Examining Health Care Proffesional, my 
employer and the Dept of Work and Pensions reserve all rights to challenge 
anything in the notes in the event we are asked to comment on the content of 
the notes at a future time. 
 4.  You are free to use your notes as you choose but if you chose to publicise 
the notes (other than in connection with correspondence with the DWP or 
under any appeal procedure) I would ask that you do not publicise my name. “ 
This wording will be available in MECs as a desk aid. Examining Health Care 
Professionals who carry out DVs should carry a copy of Annex H with them for 
use should the occasion arise. 
 
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14.  Assessing quality of service 
14.1 Claimant 
satisfaction 
Atos Healthcare carries out periodic surveys assessing the satisfaction of 
claimants.  Claimant reactions are evaluated in all aspects of the service 
including: 
 Arrangements for the visits. 
 The personal conduct and manner of the EHCP. 
The results from the surveys carried out show an overall high level of satisfaction 
with the service, but also help to identify areas where guidance, training or indeed 
the process, needs to be enhanced.  Analysis of these areas has been 
considered when drawing up these guidelines. 
14.2  Integrated Quality Audit System (IQAS) 
Our Integrated Quality Audit System (IQAS) forms a vital part of our overall 
business and quality system, aimed at supporting the delivery of a professional 
service, which provides consistent, impartial medical advice. It is linked to the 
organisational processes for complaints, assessing customer perceptions, 
training and recruitment of staff.  
The IQAS system is based upon: 
 A standard process that allows suitably trained and experienced doctors to audit 
completed work against defined standards of professional practice. 
 Systematic feedback of results and trends linked to the need for ongoing training 
and guidance. 
 A mentoring system with each EHCP having a nominated experienced 
professional colleague responsible for giving advice and for providing 
feedback including positive support. 
14.2.1 
The audit system addresses four areas of each product: 
1.  Presentation and process - This area relates to matters such as legibility, 
completeness and clarity. It includes no medical issues and may be assessed 
by a non-medical person. 
2.  Medical examination – This embraces all aspects of the medical 
examination, including history taking, formal clinical examination and the 
expression of clinical findings. 
 
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3.  Medical reasoning – This concept includes all the step-by-step reasoning 
and deduction after consideration of the available evidence, and/or 
performance of a medical examination, and the formulation of advice to the 
DM. 
 
4.  Professional Issues – This encompasses the general principles of medical 
good practice that underpin all Atos Healthcare’s work. 
14.2.2 Key 
requirements 
The customer requirements, or Key Requirements, as expressed in the contract, 
form the basis of any decision on the quality of a product, and form subdivisions 
of the areas above. 
 
AREAS KEY 
REQUIREMENTS 
LEGIBLE 
IN PLAIN ENGLISH 
CONSISTENT 
PRESENTATION 
PROCEDURALLY CORRECT 
AND 
ALL KEY QUESTIONS ADDRESSED 
PROCESS 
FULLY JUSTIFIED 
MEDICAL ISSUES EXPLAINED FULLY 
NON-PRESCRIPTIVE 
MEDICAL 
APPROPRIATE MEDICAL EXAMINATION 
EXAMINATION 
ALL MEDICAL ISSUES ADDRESSED 
MEDICALLY REASONABLE AND LOGICAL 
MEDICAL 
IN ACCORD WITH ATOS HEALTHCARE 
REASONING 
GUIDELINES 
IN KEEPING WITH CONSENSUS OF MEDICAL 
OPINION 
IN KEEPING WITH ATOS HEALTHCARE 
PROFESSIONAL 
GUIDELINES 
ISSUES 
CORRECT PROFESSIONAL HANDLING 
14.2.3 Attributes 
There are a number of factors to be taken into account when considering a Key 
Requirement
 and these are termed attributes. 
Some of these are benefit specific and are easily apparent to anyone with an 
appropriate level of technical benefit skills; others are specific medical factors, the 
correctness, or otherwise, of which will not necessarily be visible to our customer.  
All the attributes are based on requirements that are specified in training or other 
guidance material, e.g. EHCP handbooks, Guidance Notes for EHCPs etc. 
Some attributes carry more weight than others do. Some are merely “desirables” 
in that they are not essential to good quality but enhance the product without 
being vital to its acceptability. Others are defined as key attributes in that they 
are a prerequisite for quality and if unsatisfied will render the product 
unacceptable.  These key attributes carry an asterisk in the table. 
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All the attributes are coded which allows for easier collection and analysis both at 
an individual, unit, and national level.  The information from these analyses are 
used to feed back to individuals, to work towards a consistent standard across all 
units, and to feed back into training to support the maintenance and improvement 
of quality at a national level. 
A list of attributes for EHCP work is shown at Appendix C 
14.2.4 
Audit and feedback processes 
A limited number of employed doctors working for Atos Healthcare are appointed 
as auditors, using specific selection criteria.  They undergo a training and 
accreditation process.  Only after successful completion of this process are they 
allowed to carry out audit.  Their work is subject to ongoing monitoring by an 
Internal Validation Group (IVG), which looks to maintain a consistent standard 
between auditors.  Auditors are reaccredited annually subject to satisfactory 
monitoring of their work. 
All EHCPs should expect to receive feedback on their performance from their 
Medical Manager or mentor.  This feedback should provide an overall 
assessment of performance focusing upon what went well along with any areas 
where improvements could be expected.    
The results of audit where any training needs or additional support are identified, 
are fed back to the individuals concerned by their mentors.  The delivery of this 
feedback is itself monitored by the same system that collects and analyses the 
data from the audit.  The system prompts action where the feedback has not 
been given and the outcome recorded. 
 
 
 
 
 
 
 
 
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15. Complaints 
 
 
15.1  Definition of a complaint 
The current definition of a complaint is a clear expression of dissatisfaction about 
the services that we provide that originates from a claimant.  A complaint can be 
made: 
 By the claimant or their authorised representative, including MPs. 
 Verbally or in writing.  Verbal complaints can be made in person or by telephone. 
Written complaints may be by letter, fax, e-mail or using the customer service 
leaflet. 
15.2  Why are complaints important? 
Complaints are important since they provide information to reduce dissatisfaction 
and to improve the service that we offer. They give the chance to resolve any 
dissatisfaction and prevent escalation of the complaint. They also identify training 
needs and problem areas.  
Atos Healthcare values the information gathered from claimants who feel they 
have cause for complaint.  Statistics gathered on the volumes and types of 
complaint received are passed to the DWP as a requirement of the contract with 
them.  This information is also summarised, along with information from claimant 
surveys and other enquiries and feedback, into a quarterly report.  This is used to 
formulate an ongoing action plan for improvement of quality of service and this is 
passed to the DWP with details of progress made. 
15.3  The complaints procedure 
When someone is dissatisfied with the service received from Atos Healthcare the 
formal complaint procedure is followed. Some complaints are received directly 
from the claimant or their representative. Other complaints about Atos Healthcare 
are referred from the DWP to the Customer Relations Team (CRT) in Atos 
Healthcare, for investigation and response. A Customer Service leaflet is 
available on request to explain further the formal process.  The leaflet is issued to 
callers who wish to lodge a complaint in person, and the leaflet is issued with an 
acknowledgement letter on receipt of a written or telephoned complaint. The 
procedure is outlined in the following flow diagrams. 
 
 
 
 
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15.3.1 
The Complaint Procedure 
 
 
 
Custom er provides feedback – whether written or 
verbal 
 
 
 
 
Com plete Pro-form a 
 
 
 
 
Pass Pro-form a to Custom er Relations Manager 
 
 
 

 
 
 
Treat as Feedback 
Is it an actual 
 
com plaint? 
 
 
 
 
 
Y
 
 
N  
  Advise customer and pass 
 
Is it for Atos 
com plaint to Business Unit 
or  
 MSC M T 
H ealthcare? 
 
 
 
Y
 
 
 End 
Record com plaint
 
 
 
 
 
Acknowledge com plaint if com plaint not already 
 
 
been resolved.  Include explanation of the 
Reconsideration and Appeals Process 
 
 
 
 
 
Y
 
Is the com plaint a 
 
Refer to SCIT, via the National 
potential SCIT case? 
Custom er Relations Team  
 
 
 
 
 
N
See SCIT  C ode of Practice 
 
 
 
Y
G ive full response 
Can im m ediate 
 
 
response be given? 
 
 
 
Clear on CMS 
 
N
 
Undertake relevant investigation** 
 
 
Action taken* 
 
 
Issue interim  update 
 
 
Request for 
reconsid eration of 
 
original  
 com plaint 
Evaluate 
respons  e 
 
 
 
Review 
 
 
 
 
* Exam ples of acti  
on include: feedback, rem edial action, inform ation forwarded to Dept, apology 
 
 
** Op  tions include: Examining doctor/MM/MEA/Admin staff/Business Unit/National Customer Relations Team/Witnesses/ Customer – Rep -Carer 
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15.4  Customer Relations Team (CRT) 
The CRT is responsible for ensuring that all complaints are handled in 
accordance with the guidelines. It is centrally based and is made up of Customer 
Relations Managers (CRMs). The role of the CRM includes receiving complaints 
and then investigating, responding to and reporting on them.  The team provides 
advice and support in handling complaints. 
A Customer Relations Medical Advisor (CRMA) is also based with the CRT. Their 
role includes providing medical input on behalf of the Medical Manager at the 
individual MSECs, to inform the first full response to the complaint. 
The CRT provides advice as to whether a complaint should be referred to the 
Serious Complaints Investigation Team (SCIT) (see below). It also co-ordinates 
SCIT investigations. They also make recommendations on minimising complaints 
or the risk of them, and provide responses to, for example, parliamentary 
questions and ministerial correspondence.  The CRT also acts as convenor to the 
Independent Tier (see below). 
15.5  Complaints and the EHCP 
The EHCP may become involved in this process whilst in face-to-face contact 
with the claimant, should the person indicate that they wish to provide feedback.  
At a later stage, the EHCP may be asked to provide specific comments in 
response to a complaint received about an examination. 
As an EHCP, the claimant may choose to approach you regarding feedback they 
may have relating to how their medical assessment has been handled. If you 
receive a complaint during the examination, you are asked to do everything 
possible to rectify the situation to the satisfaction of the claimant. 
When performing an examination in the claimant’s home, make sure that you 
have a copy of the Customer Care leaflet with you.   
If the claimant wishes to provide feedback, explain the different options available 
to them for sending their feedback to Atos Healthcare.  If the claimant wishes for 
their verbal feedback to be recorded in writing, you should record the feedback 
and give the claimant a copy of the Customer Care leaflet.  
15.5.1 
What do claimants complain about? 
Complaints are categorised according to their nature: 
 EHCP’s manner or conduct – examples include allegations that EHCPs were 
“rude, arrogant, did not listen, did not write down everything said, did not give 
their name, inappropriate examination, inappropriate comments etc”. 
 Content of examination – disagreement about whether or not certain clinical 
tests should have been used e.g. whether blood pressure should have been 
taken, whether chest should be examined under or over clothing etc. 
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 Length of examination – e.g. too long or too short. 
 Clinical findings – e.g. what the EHCP has written on the medical report as their 
opinion or conclusions about the claimant’s level of care and/or mobility 
requirements. 
 Administrative issues – e.g. lack of warning regarding date of visit, not sufficient 
time to arrange for a carer or relative to be present. 
 Other – complaints about administrative staff and about issues not directly the 
concern of Atos Healthcare, which may require comment. 
15.5.2 
Complaints about EHCPs 
The majority of complaints concern the circumstances of the actual medical 
assessment by the EHCP. 
 
32.1% of all complaints refer to the doctor's manner. 
 
28.9% refer to the content of the examination. 
 
12.1% refer to the clinical findings. 
The figures above (for 2007) are based on an analysis of complaints arising from 
all types of benefit assessments including DLA/AA. 
Specific complaints relating to EHCPs are pursued based on the seriousness or 
complexity of the complaint. 
15.5.3 
Feedback you should not respond to 
Sometimes the claimant may wish to complain on matters that do not relate to 
our services.  You must not become involved in explaining such matters.   
Complaints or feedback regarding the following (non-exhaustive) list of examples 
should be referred to a CRM: 
  Rules of entitlement to a benefit 
 Benefits process itself 
 Actual design or nature of any policy 
 Complaints about the policy 
 Service provided by the Business Unit 
 Appeals or decisions to disallow benefit 
  
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15.5.4 
Assisting in an Investigation 
From time to time, you may receive an enquiry or request for input from the 
Medical Manager or CRT as part of their investigation into a complaint.  In these 
circumstances, you are expected to provide a written response within five 
working days.  You will be supplied with a copy of the claimant’s letter of 
complaint and other relevant documents, such as a copy of your examination 
report, as dictated by the circumstances of the complaint.   
Your contribution is vital to the successful conclusion of the complaint, as without 
it, the response given to the claimant by Atos Healthcare will be incomplete and 
unsatisfactory.   
You should ensure that you supply a comprehensive and relevant response that 
addresses all of the issues raised in relation to your interaction with the claimant.  
Lack of detail will hamper the CRM or Medical Manager when explaining your 
position to the claimant. 
If any clarification or additional information is required, the CRM or Medical 
Manager may choose to contact you for further details.  During the course of the 
investigation of a SCIT complaint, it is normal practice to ask you to attend for an 
interview to give oral evidence.  On some occasions, an interview with an Atos 
Healthcare manager may be arranged during the investigation of a sensitive 
complaint. 
If you are unable to respond within five working days of receipt, you should 
contact the CRT to explain the position and provide a likely date as to when you 
will be able to supply a reply. 
Depending on the content of the complaint, you may consider it appropriate to 
contact your defence society to discuss your response before dispatching it to 
Atos Healthcare. 
Under the Data Protection Act, your response to Atos Healthcare may be copied 
to the claimant if they request sight of it. 
For your information, you will be sent a copy of the reply that Atos Healthcare 
sends to the claimant. This will be provided by the CRT or by your Medical 
Manager if further action is appropriate. 
15.5.5 Follow-up 
action 
Following completion of a complaint action, the file is passed to the Medical 
Manager of the area in which the EHCP is based. They will review the complaint 
and decide what follow-up action is required. The Medical Manager will also 
consider the EHCP’s previous complaint record. The categories of action are 
listed below. 
 No action: No issues have arisen from the complaint that require 
communication with the EHCP (the EHCP is provided with a copy of the 
response letter for information only) 
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 Proactive feedback: Evidence may be conflicting or irreconcilable. However, 
while emphasising that it has not been possible to draw conclusions from the 
complaint, it is appropriate to state that the events that have been alleged by 
the claimant to have taken place would not be compatible with Atos 
Healthcare standards. Proactive feedback consists of sending the EHCP a 
copy of the response to the complaint, in which this view is expressed. 
 Remedial action: Specific action to be taken in consultation with the EHCP.  For 
example, interview / discussion followed by additional training or monitoring. 
 Formal action: Formal Personnel action will be instigated. This includes the 
revocation of approval, capability or disciplinary procedures. 
15.6  Escalation of a complaint 
If the complainant remains dissatisfied with the response further investigation will 
take place.  The complaint will be referred to the Medical Manager responsible for 
the area where the complaint originated.  Any fresh issues will be investigated 
and addressed, new evidence acquired and/or a fuller explanation offered to the 
complainant. 
15.7 Independent 
Tier 
If the complainant continues to be dissatisfied, although all issues have been 
addressed, the complaint can be referred to the Independent Tier of the 
complaint process.  The Independent Tier is made up of people who are not part 
of Atos Healthcare, DWP or Welfare Rights Groups. 
The Independent Tier has no legal authority or executive responsibility in relation 
to Atos Healthcare.  It will consider whether Atos Healthcare has adhered to the 
approved complaints process for handling of the complaint.  
This will include looking at whether or not all issues have been identified and 
addressed, whether the complaint was dealt with promptly and efficiently, 
whether sufficient investigation was undertaken and the appropriate individuals 
asked to comment.   
A parallel independent medical quality review will be conducted by a qualified 
and approved medical practitioner.  This will be undertaken when there are 
issues within the complaint that relate to the medical quality of the medical report 
in question. 
The Independent Medical Practitioner will consider whether the relevant medical 
report considered as part of the complaint investigation has been completed in 
accordance with Atos Healthcare’s quality and professional standards.  The 
medical practitioner will specifically comment on whether the advice provided 
was:  
 Fair and impartial, in accordance with the Department for Work and Pension's 
Equal Opportunities policy 
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 Medically  correct 
 Complete, justified, and consistent 
 Expressed in terms readily understood by the District Office customer 
 Legible, where given in writing 
 Within the consensus of current medical opinion. 
The Independent Tier will not provide views or judgements to any person outside 
Atos Healthcare on policy issues or decisions of the decision-making authorities. 
It is not part of the role of the Independent Tier to enter into discussions about the 
merit of a complaint with the claimant or any other party to the complaint.  
However, when carrying out its review, the Independent Tier, or Independent 
Medical Practitioner, may contact the claimant, or any party to the complaint to 
seek clarification, or seek expert advice to resolve issues requiring additional 
guidance.  They will do this via the Convenor to the Independent Tier (CRT) who 
will arrange any contact or obtain additional guidance for the Independent Tier. 
The Authority, or representatives of a recognised Welfare Groups, may observe 
the Independent Tier review.  This will be agreed with Atos Healthcare and 
arranged by the Convenor who will also obtain consent from the claimant or 
customers concerned. 
The Independent Tier, or Independent Medical Practitioner, will determine the 
appropriate method for reviewing any particular complaint referred to them.  
However, the findings of the Independent Tier will be communicated in an 
approved format. 
When a referral is to be made, a nominated Customer Relations Manager will act 
as Convenor to the Independent Tier. The Convenor will assemble all paper from 
the complaint file, with a schedule of events, and forward these to the 
Independent Tier, including a set of papers to the Independent Medical 
Practitioner.  Following the review the Convenor will notify the Customer 
Relations Team Leader of the outcome.  The Team Leader will determine the 
nature of any remedial action appropriate in any case after consultation with 
senior operational managers.   
The Convenor will forward the findings of the Independent Tier to the claimant 
with information about any remedial action taken by Atos Healthcare because of 
the findings of the Independent Tier.  This will also be provided to the Authority as 
agreed. 
15.8  Serious Complaint Investigation Team (SCIT) 
A serious complaint cannot be precisely defined but would normally fall into one 
of the following areas: 
 Assault as a consequence of examination 
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 Injury as a consequence of examination 
 Inappropriate intimate examinations 
 Missed diagnosis of a serious nature 
 Racial  abuse 
 Sexual  abuse 
 Serious breaches of professional conduct 
 Theft or fraud 
 Criminal  activities 
The Medical Manager will recommend to the CMO whether a complaint is 
categorised as a SCIT matter. The CMO decides whether a complaint should be 
investigated as a SCIT and also advises on initial action before the SCIT 
investigation (including EHCP suspension) and remedial action following it. 
The CRT is responsible for facilitating the process, liaising with the Medical 
Manager and the SCIT. 
Atos Healthcare deals with SCIT cases urgently. These cases are processed with 
particular regard to confidentiality.  The importance of considering the rights of 
both the claimant and the individual against whom the complaint has been made 
in these cases is paramount. 
Once it is established that a complaint is to be investigated by the SCIT, the CRT 
takes over responsibility for the complaint investigation. The SCIT comprises a 
non-medical member, who is a senior manager from Atos Healthcare Operations, 
and a doctor form the pool of experienced Atos Healthcare SCIT doctors. The 
doctor will have no connection with the area where the complaint has arisen. If 
the practitioner is an employee, the non-medical member will be from Atos 
Healthcare HR. 
The SCIT will conduct a detailed investigation that involves notification to the 
EHCP of the complaint and subsequently interviewing the EHCP, claimant and 
any appropriate witnesses.   
On conclusion of the investigation, appropriate action will be taken in consultation 
with the Medical Manager and with Atos Healthcare HR. 
The need for disciplinary or other remedial action will be considered.  In the case 
of a substantiated serious complaint made against a contracted doctor, the VPPC 
will be informed that no further work will be offered to that doctor. 
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Appendix A - Atos Healthcare Professional 
Standards 

Personal Conduct 
1.  All work will be carried out in a manner that recognises the right of everyone to 
be treated with respect whatever his or her gender, sexual orientation, race, 
religion, nationality, culture, age, health, (dis)ability, marital status and physical 
characteristics or appearance. 
2.   In dealings with claimants and their representatives, Atos Healthcare employed 
staff and self-employed Contract Medical Assessors will be: 
 Accessible 
 Punctual 
 Reliable 
 Presentable 
 Approachable 
 Courteous 
 Friendly. 
3.  When carrying out an examination of a claimant, to support the advice giving                             
process, staff will: 
 Introduce himself or herself to the claimant and wear a name badge or offer 
other official identification. 
 Make the claimant welcome and feel at ease. 
 Be polite at all times. 
 Encourage a person accompanying the claimant to be present during the 
examination if so desired by the claimant. 
 Explain the purpose of the examination. 
 Explain what the examination entails. 
 Allow the claimant time to give their history, asking questions in a non-
adversarial manner and following the relevant guidance (such as this 
handbook) 
 
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 Carry out a relevant examination to provide the information necessary to give 
and justify medically reasonable advice. 
 Carry out the examination gently to avoid any unnecessary discomfort. Virtually 
always, only active (and not passive) movements of the limbs are appropriate. 
 
4. When giving Advice: 
 Atos Healthcare advice will be objective, independent, fair and impartial, ethical, 
and given in accordance with our contractual obligations. 
 It will conform to the consensus of medical opinion and the balance of 
probability. 
 It will be of an appropriate depth, scope and focus, and presented with a clarity 
that will permit the DM to give reasonable consideration to the medical issues. 
5.The following clarify these terms, concepts and definitions: 
Objective 
Based on evidence. 
Independent 
Without the influence of carer responsibility, or involvement 
in any other aspect of the claim. 
Fair and Impartial 
With no personal interest, of any sort, in the outcome of the 
claim under consideration. 
Everyone has the right to work without fear of harassment.  
The company is committed to eliminating such behaviour 
and creating a productive working environment where 
everyone is treated with dignity and respect whatever their 
gender, sexual orientation, race, religion, nationality, 
culture, age, health, (dis)ability, marital status and physical 
characteristics or appearance.  Every employee and person 
acting on behalf of the company has a duty to protect and 
respect this right. 
(Harassment being a generic term that encompasses 
bullying and victimisation). 
Ethical 
Conforming to the code of Professional Ethics as laid down 
by the General Medical Council / Nursing and Midwifery 
Council 
Appropriate Depth  Sufficient factual detail obtained to support the advice. 
 
 
 
 
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Scope 
Addressing all the questions asked. 
Covering all relevant issues, including details of an 
appropriate medical examination when required. 
Without reference to entitlement. 
Answering questions posed by the customer without 
compromising any subsequent decision making process. 
Focus 
Relevant. 
Medically logical. 
In accordance with contractual obligations. 
Further Medical Evidence should be appropriate, and 
obtained by the most economical method. 
Given in good time, taking account of any targets or 
deadlines. 
Clarity 
Concise. 
In terms understood by the customer. 
Legible when written. 
It will be clear in its account of Further Medical Evidence 
usage. 
Free of contradictions or conflicts. 
The standards are measured by a combination of customer and claimant 
surveys, peer group audit, direct observations etc.  
 
 
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Appendix B - Professional Standards - Disability 
Living Allowance and Attendance 
Allowance 

Atos Healthcare function 
Standard 
 
 
 
 
 
EHCP must be: 
  Presentable in appearance 
 
  Courteous in approach 
 Punctual 
 
 
 
 
 
Reports must: 
 Be 
legible 
 
 Be 
comprehensive 
  Be consistent within themselves 
 Be 
impartial 
  Be clearly understandable 
  Be medically correct 
  Not make any reference to 
entitlement 
  Contain non-prescriptive advice in 
accordance with the relevant 
legislation 
  Be free of embarrassing, confidential 
and harmful information 
 
 
Measured by 

1.  Review by Registered Medical Practitioner. 
2.  Comments from DM – assessing legibility, consistency, clarity, helpfulness. 
3.  External claimant questionnaire - assessing appearance and manner. 
4.  Level of substantiated complaints. 
 
 
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Appendix C - Attributes for examinations in 
DLA/AA 

Definition and interpretation of generic attributes 
 
ATTRIBUTE CODE 
“*Legible” – The evaluation of legibility is inevitably a subjective task. 
However, some measure of the ease with which a product may be read 
is necessary in our business. A passage may be regarded as legible if it 
G06 
can be read at not less than half the average speed of printed text, and 
no key words or phrases are indecipherable. 
“Clearly presented” - Good presentation is an important component of 
clarity. Faced with a lengthy passage of free text it is often difficult for 
the reader to efficiently identify its components and structure. 
G10 
Underlined headings and logical sectioning of text greatly aid 
communication between author and reader. 
“Free from medical abbreviations” - Medical abbreviations should not 
be used. Although certain shorthand medical terms may be known to 
most readers it is nevertheless good practice to avoid their use 
G12 
wherever there is any possibility of confusion. 
“Free from medical jargon” - The use of medical jargon, which 
includes medical abbreviations, can lead to misunderstandings. The 
term “medical jargon” is distinguished from technical medical language 
G13 
(see “Clear explanation of medical issues”). Examples of medical jargon 
would be “Oedema º cyanosis º….” or “Nodes neck  R>L”. 
“In plain English” - The use of uncommon or long words where 
everyday, commonly used terms would be equally effective is not good 
G15 
practice. Sentences should be brief, clear and to the point. 
“*Consistent” - A report should be consistent in that it must contain no 
internal contradictions. A fact or opinion given in one part of a document 
G03 
should be in accord with all other components of the product. 
“*In accordance with defined procedures and current advice” - This 
 
attribute requires that a report must be procedurally correct. It should be 
prepared in accordance with current usage as defined in reference 
G04 
publications for EHCPs. 
“*In accordance with legislation” - While the EHCP’s role is wholly 
advisory and not statutory, the work is nevertheless carried out within 
the framework of current legislation. It is therefore a required attribute 
G05 
that advice is given in accordance with the law. 
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“Appropriate response to incorrect documentation” - The EHCP 
should be able to recognise the fact that incorrect documentation has 
been provided. The practitioner’s response will vary according to 
G08 
circumstances, but above all should not compound the error. It should 
reflect the needs of the business and the requirements of the customer. 
“*FME consideration recorded” - It is important that the customer is 
made clearly aware of the evidence which the EHCP has considered in 
giving advice. Further medical evidence is of particular importance in 
G11 
this context. 
“*Complete answers to all questions raised” - No area of a report 
should be left incomplete. If specific questions are raised by the 
G02 
customer they should all be addressed. 
“*Advice adequately justified” - Advice which is not accompanied by 
justification is no more than a gratuitous opinion. This attribute requires 
that the author of a report gives a clear explanation of the reasons for 
G16 
giving certain advice and the underlying evidence by which he was 
guided. 
“*Clear explanation of medical issues” - A report written solely in 
technical medical terms is valueless to the non-medical customer. This 
attribute does not require that such terms are avoided, merely that they, 
G01 
and the underlying medical reasoning, are clearly explained for the 
benefit of the non-medical reader. 
“Appropriately detailed” - Excessive detail compromises clarity. 
Equally, failure to provide adequate information may compromise 
G09 
decision-making. Skilled report-writing avoids these extremes. 
“*Full clarification of contradictions and/or conflicts” - Conflicts of 
evidence should be addressed. Even where the EHCP is unable to 
provide en explanation for such a conflict, he should demonstrate that 
G14 
the difficulty has been recognised. 
“*Not compromising decision-making” - The EHCP’s report should 
contain no allusion to entitlement to benefit, or express any view 
G07 
regarding the outcome of a case. 
 
 
 
 
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Presentation and process attributes 
 
Key 
Attribute
Attribute 
Requirements 
Code 
* Legible 
G06 
Legible and clear 
Clearly presented 
G10 
Free from medical abbreviations 
G12 
In Plain English 
Free from medical jargon 
G13 
In plain English 
G15 
Consistent * 
Consistent 
G03 
*In accordance with defined procedures and current 
G04 
advice 
* In accordance with Legislation 
G05 
Procedurally Correct 
Appropriate response to incorrect documentation 
G08 
* FME consideration recorded 
G11 
All Key Questions 
*Complete answers to all questions raised 
G02 
Addressed 
Fully Justified 
* Advice adequately justified 
G16 
*Clear explanation of medical issues 
G01 
Medical Issues 
Appropriately detailed 
G09 
Fully Explained 
* Full clarification of contradictions and/or conflicts 
G14 
Non-prescriptive 
*Not compromising decision making 
G07 
Key 
Attribute
Professional Issues Attributes 
Requirements 
Code 
In keeping with 
Atos Healthcare 
*Standards independent, impartial, ethical, honest and fair 
P01 
Professional 
Standards 
Appropriate action taken on harmful, confidential, and 
Correct Professional 
P102 
embarrassing information 
Procedures 
Appropriate action taken on unexpected clinical findings 
P03 
 
 
 
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Key 
Attribute
 
EHCP Report Attributes 
Requirements 
Code 
*Appropriate clinical and past history recorded 
S10 
Client’s description of variability recorded 
S13 
Current medical treatment described 
S18 
Current symptoms described 
S19 
Hospital treatment and appointments recorded 
S30 
Medication recorded 
S37 
Side effects recorded and explained 
S66 
Diagnosis recorded and explained if necessary 
S67 
Clear record of customer’s reported impairments and restrictions 
C28 
Appropriate pen picture present 
C10 
Account of average day activities present 
C18 
Account of average daily activities functionally focussed and 
C19 
Appropriate 
relevant 
Medical 
Social / cultural issues addressed 
R71 
Examination 
*Clear record of a careful structured examination of all relevant 
C01 
areas 
*Clinical findings expressed clearly and concisely 
C03 
*Examination covers all known conditions 
C04 
*Inappropriate signs clearly described 
C06 
*Record of appropriate mental health assessment, if indicated 
C08 
Appropriate examples of observed behaviour recorded 
C12 
Clinical tests appropriate to specific conditions applied and 
C13 
recorded 
Measurements recorded properly and appropriately 
C14 
Style of recording permits future comparison 
C15 
Date and mode of development of symptoms recorded adequately 
C17 
Epilepsy questionnaire completed if required 
C29 
*Mobility opinion consistent with clinical findings 
R26 
*Opinion on safe mobility supported and consistent with clinical 
 
findings/observed behaviour/anecdotal evidence 
R35 
*Day attention needs are medically justified and consistent with 
R79 
clinical findings 
*Main meal opinion: Opinion justified and consistent with clinical 
R67 
Medically Reasonable
findings 
and Logical 
*Day supervision: expressed needs medically justifiable 
R11 
*Night attention: needs are medically justified and consistent with 
R27 
clinical findings 
*Night supervision: expressed needs medically justifiable 
R28 
*Opinion based on clinical findings and observation and not on 
R33 
clients claimed needs 
*Medically reasonable and logical 
R25 
*Inconsistencies dealt with clearly 
R20 
Attention opinion checklist; all tick boxes justified if help needed 
R48 
Clear categorisation (attention vs. supervision) of help required in 
R49 
All Medical Issues 
maintaining personal hygiene 
Addressed 
* FME clarified and interpreted when required 
R63 
   Variability issues clarified 
R103 
Clear link between observations and claimed disability 
R106 
Appropriate justification given for advice on prognosis 
R104 
In Keeping With 
*Advice conforms to consensus of medical opinion and balance of 
Consensus of 
probabilities 
R01 
Medical opinion 
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Appendix D - Abortive Visits – Form AV1 
Form AV1 
Medical Services
 
 
 
PROVIDED BY ATOS ORIGIN ON BEHALF OF THE DWP 
Office Address 
 
 
From 
To  
 
 
Date 
 
 
 
 
As arranged, I called to examine you regarding your claim for 
 
  Incapacity Benefit 
  War Pension 
 
 
  Disability Living Allowance 
  Industrial Injuries Scheme Benefit 
 
 
  Attendance Allowance 
  Severe Disablement Allowance 
on    /    /      but you were not available when I visited. 
 
What happens next 
I will visit you on    /    /      at 
 
 
 
While I will use my reasonable endeavours to meet the specified appointment time I may be 
held up by delays incurred during previous examinations and journeys. 
 
 
Should you feel that this appointment is unsuitable please contact the visiting practitioner on 
the number below: 
 
Practitioner’s Name  
 
 
 
Phone Number  
 
 
 
 
 
 
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Appendix E - Unexpected Findings – disclosure of 
clinical information by Health Care Professionals 
to claimants’ General Practitioners 

Introduction 
Situations arise when EHCPs carrying out disability assessments may come 
across information that they feel should be reported to the claimant’s General 
Practitioner. The following section gives details of what to do in these cases. 
1) GMC / NMC Guidance 
Guidance regarding confidentiality is published regularly by the GMC and 
NMC.  It sets out the duties and obligations that EHCPs have in terms of 
maintaining patient confidentiality. It is made explicit that consent must be 
obtained from the patient (claimant) before any information is released about 
them, unless there are exceptional circumstances. It is clearly stated that the 
purpose of the disclosure and its content must be made clear to the patient 
prior to its release. In DLA/AA work it would most likely mean releasing 
information to their General Practitioner.  
There may be rare occasions when despite the patient’s inability or refusal to 
give informed consent, the EHCP may in their professional judgement feel it is 
appropriate to disclose information about that individual.  Discretion must be 
exercised within the GMC / NMC guidelines, and EHCPs must be prepared to 
justify fully their decision to take such action. The types of circumstances when 
unauthorised disclosure by EHCP s would be justified include: 
 When the release of that information is necessary to protect others from risk 
of death or serious harm; 
 When the patient requires urgent medical treatment, but cannot be contacted 
within a suitably rapid period of time. 
 When the individual is not competent to give consent. 
All practitioners are strongly advised to read the appropriate guidance notes 
from the GMC or NMC.   
If any doctor does not have a copy, then they should contact the GMC at 178 
Great Portland St, London W1W 5JE (Tel: 020 7580 7642) or visit www.gmc-
uk.org. There will be updates of the frequently asked questions on the website. 
If any nurses do not have a copy, then they should contact the NMC at 23 
Portland Place, London W1B 1PZ (Tel: 020 7637 7181) or visit www.nmc-
uk.org.  
 
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2) Procedures for dealing with unexpected findings when the 
claimant provides written informed consent
 
When an EHCP identifies a need to pass information about a claimant to the 
GP then they must provide an explanation to them why this is the case.  The 
discussion should include: 
 The information to be disclosed. 
 Reasons for the disclosure of this information. 
 A request for consent to release of the information. 
The EHCP should record relevant details of their discussion with the claimant 
on form UE1 (Rev), both in respect of the information that they have given to 
the claimant and the claimant’s response.   
For example, I advised your patient that he should report the symptom 
of coughing up blood to you and he said that he would arrange an 
appointment as soon as possible
.   
These details should be recorded on form UE1 (Rev) in the section I have 
examined your patient/reviewed your patient’s file* in connection with 
their claim to benefit.  I believe that you will wish to be aware….”
 
Informed written consent from the claimant should be obtained on the UE1 
(Rev) form and the procedural guidance must be followed in full. An example 
of this form is in Appendix F. 
The claimant should be given a copy at the time of the examination. 
The findings must be communicated to the claimant’s General Practitioner 
within 24 hours, provided that the claimant gives consent for this release. 
3) Guidance for contacting the claimant’s doctor 
 
a) Contact by telephone and letter:  

Most reports completed during a DV will not be seen by a medical member of 
staff when they are returned to the MSC. It is therefore the responsibility of the 
EHCP to report any unexpected findings to the claimant’s GP by telephone 
and record details of the conversation on form UE1 (Rev). This is outlined 
below: 
 A copy of the UE1 (Rev) form must be handed to the claimant.  
 For this purpose, each EHCP will have been issued with three spare copies of 
form UE1 (Rev) along with a piece of carbon copy paper.   
 If carbon paper is not available, the EHCP must make an exact copy on a 
separate UE1 (Rev).   
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 Each DV issued will also contain one copy of form UE1 (Rev).  
 EHCPs should contact their respective MSC to replenish stocks of UE1 (Rev) 
forms. 
Telephone contact must be made in all cases with the claimant’s medical 
attendant, to ensure compliance with the 24-hour deadline. 
In addition, in all cases, a UE1 (Rev) form must be completed and attached in 
a clearly visible position to the front of the examination report.  This should 
include details of the information passed by telephone to the claimant’s GP.  
The file must then be returned to the MSC as normal, where the administration 
clerk will issue the completed UE1 (Rev) to the GP or Medical Carer, after 
taking copies for CSD (retained for 3 months), the claimant’s file and the 
EHCP’s personal file (to be retained for a minimum of 10 years). 
For cases examined in MECs, similar general principles are used. 
b) Claimant does not have a GP: 
If the claimant does not have a GP, advise them to seek medical attention, 
and provide them with an additional copy of the UE1 (Rev) detailing the clinical 
findings.   
4) Procedures for dealing with unexpected findings when the 
claimant refuses consent to release information    

If the claimant refuses to give consent, the EHCP should not normally make 
any attempt to contact the GP by telephone or by letter.  The claimant should 
be asked to sign the relevant section of the UE1 (Rev) to indicate this refusal.  
In these circumstances, the EHCP should only complete the form partially, to 
provide the claimant’s name and NINO for identification purposes, and details 
of the clinical condition that raised concern.  There is no need to complete the 
GP contact details, as the form is not intended for despatch.  Nevertheless, 
copies of the partially completed UE1 (Rev) should be retained on the 
claimant’s file, the CSD compendium file and the EHCP’s personal file, in 
accordance with current guidance. 
A factual description of the actual unexpected finding should be included in the 
examination report in the usual manner. 
 
a) When the claimant refuses consent to release information and refuses to sign the 
UE1 (Rev) 

If the claimant refuses to give consent and, in addition refuses to sign to 
relevant section of the UE1 (Rev) form, the EHCP should annotate the form 
with details of the circumstances.  The process should then follow along the 
lines described above.  
 
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 b) When the claimant refuses consent to release information but in your 
professional judgement you consider that the release of that information is 
essential 

Whenever the claimant refuses to provide consent (written or verbal) despite 
the EHCP’s best endeavours to explain why this is necessary, the EHCP must 
respect their views but also must determine whether disclosure is still essential 
(see earlier).  If the release is considered essential then the EHCP must 
complete all relevant sections in the UE1 (Rev), providing a justification for the 
disclosure despite the claimant’s refusal to provide oral/ written consent. 
In these circumstances, the usual unexpected findings process must be 
followed in full to ensure that a copy of the UE1 (Rev) is sent to the GP, 
contact is made by telephone where appropriate, and copies are filed as 
stipulated. 
5) General procedural guidance 
a) Harmful information 
See section 12 
b) Referral to hospital 
Circumstances may occur when you may consider it necessary to refer the 
claimant to hospital immediately.  In these instances, a hospital referral letter 
must be issued to the claimant followed up with a telephone call to the GP or 
Medical Carer and confirmed in writing using a UE1 (Rev) form, which should 
be fully completed to include the claimant’s signed agreement wherever 
practical.  If a signed agreement is not practical, for example the claimant is 
unconscious or is in such dire straits that is would be insensitive to request a 
signature (e.g. experiencing a myocardial infarction), the EHCP should briefly 
describe the situation on form UE1 (Rev). 
Once again all telephone conversations between the EHCP and the claimant’s 
GP or Medical Carer must be recorded on the UE1 (Rev). 
If the claimant refuses to be referred, the EHCP will need to consider whether 
the circumstances fulfil the exceptional criteria, in which unauthorised 
disclosure to the GP is professionally justified.  The EHCP should make such 
a judgement in strict accord with the precepts outlined in the GMC / NMC 
guidance. 
c) Advising the claimant 
In all instances of unexpected findings, the claimant must be advised to 
consult their GP/Medical Carer in the near future, and the degree of urgency 
communicated to the claimant will depend upon the clinical judgement of the 
EHCP.  Due sensitivity must be observed when advising the claimant to attend 
their GP and you must ensure that your manner does not give rise to undue 
concern. 
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d) Undiagnosed mental health conditions 
In all cases where a previously undiagnosed mental health disease has been 
identified, the procedure on disclosure described above should be followed in 
full, leading where indicated to completion of a UE1 (Rev) form to the 
claimant’s GP/Medical Carer providing details of the condition assessed.  
However, this does not imply that a UE1 (Rev) should invariably be completed 
in every case in which a mental health assessment has been performed.   
If in any circumstances there is doubt on the correct way to proceed, EHCPs 
should consult CSD for advice. 
6) Customer Service Desk (CSD) 
Role of CSD 
CSD will be an initial point of contact for EHCPs who have queries regarding 
the action to take and from claimant’s GPs or Medical Carers on receipt of a 
completed UE1 (Rev) from Atos Healthcare. 
CSD will set up and maintain a file containing copies of all completed UE1 
(Rev) forms in date order. This will assist CSD staff in dealing with enquiries 
from GPs and Medical Carers. Copies must be retained for a minimum of 
three months. 
CSD will be able to call upon the services of an experienced MA if any 
difficulty is encountered. 
7) Unexpected findings arising during the course of file work 
If a EHCP wishes to pass on information uncovered in the documentary 
evidence that they feel the GP may be unaware of, the consent of the claimant 
must be obtained first. 
The EHCP should write to the claimant and request the claimant’s written 
consent for disclosure.  A first-class reply paid envelope for reply should be 
enclosed.  The letter to the claimant must include an indication of the nature of 
the information that is intended for communication to the GP, although this 
must of course be done in such a way as to avoid engendering undue alarm.   
The letter should be passed to the CSD Team Leader who should take a 
photocopy of it and place the copy in the CSD compendium file, giving it a five-
day review period.   
If a positive response to the request for consent is received, it should be linked 
to the file and passed to an MA immediately.  The MA should then contact the 
GP by telephone on the same day – this is important to reduce the likelihood 
of a situation developing where the claimant contacts the GP before Atos 
Healthcare has had an opportunity to pass on the relevant information.   
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Page  101 
 
 

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In addition to telephoning the GP, the MA must complete form UE1 (Rev) with 
the relevant details. This form should be handed to the administration clerk, 
who will issue the completed UE1 (Rev) to the GP or Medical Carer, after 
taking copies for CSD (retained for 3 months), the claimant’s file and the 
EHCP’s personal file (to be retained for a minimum of 10 years).  In file work 
cases only it is not necessary to issue a copy of the UE1 (Rev) to the claimant, 
as they will already have been provided with relevant details in the earlier 
letter seeking their consent. 
If after five working days the consent has not been returned, the CSD Team 
Leader should pass the photocopy to a EHCP who will telephone the claimant 
and ask if the letter has been received and is being returned.  Details of the 
telephone call and any conversation should be recorded on the back of the 
photocopy.  Following the telephone conversation: 
 If the claimant informs the MA that the letter has been/will be returned, wait 
for a further two days for the letter.  If no reply is received after a verbal 
reminder, then it should be assumed that consent is withheld. 
 If claimant refuses to reply to the letter, the MA should consider if release of 
information without the claimant’s consent is justified. 
Copies of the letter requesting consent, results of any telephone 
conversations, and consent/refusal to consent should be held in the CSD file, 
the EHCP’s file and the claimant’s referral file. An example of the letter that 
can be used is in Appendix F. 
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  102 
 
 

Medical Services 
Appendix F - UE1 (Rev), POID 1 & UE 2 
MEDICAL SERVICES
REPORT OF UNEXPECTED FINDINGS FOLLOWING MEDICAL EXAMINATION
PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS
To:
From:
Tel No:
Our Ref. (NINo):
GPs  Fax No:
Date:
Dear Doctor
Information about your patient:
Name:
Date of Birth:           /              /
Address:
examined your patient*/reviewed your patient’s file* in connection with their claim to benefit.  I believe that you wil  wish to be aware
that in the course of this I have found the fol owing:
Claimant Consent:
I confirm that the examining doctor has discussed with me the reasons for the release of information to my GP and I give consent* / do
not give consent* 
to the release of that information. (* delete as appropriate)
Signed:
(claimant)
Date:
             /                /
Please note that:
 I have discussed/forwarded my reasons for requesting consent to release information to their GP but the claimant
has declined/not responded.  However in my professional judgement I believe that the release of that information is indicated for the
fol owing reasons:
GP notified by telephone
   Time notified GP
:
I have advised your patient to consult you
Yours sincerely,
Signed:
(Doctor)
Date:
             /                /
Name (Print):
Official Use Only
                            (tick):
Initials/date/location
Copy (tick):
Initials/date/location
Faxed to GP:
CSD
Sent to GP:
Claimant’s File
Claimant copy:
Doctor’s File
                Do Not Weed (DWP Purposes Only)
UE1 (Rev) 10/01
 
 
 
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  103 
 
 

Medical Services 
MEDICAL SERVICES 
 
 
 
PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS 
 
 
PROOF OF IDENTITY SLIP 
 
 
Please complete part 1 with the claimant’s details. 
 
 
PART 1 
 
 
 
Full Name (please print)…………………………………………………………... 
 
 
Date of Birth………………………………………………………………………... 
 
 
Signature…………………………………      Date……………………………….. 
 
 
 
 
 
 
PART 2 
For office use only 
 
 
 
 
   PP                                      ECID   
 
        SAL 
 
 
 
HOID                
 
 
   DP                                             CGC                                         BC             
                        HODOC              
     
   WS                                           BANK                                        MC                                      
  TU                  
 
 
 
  BSOC                                          TP                                          PRV                                                   AC                  
 

 
  BILLS                                        GV3                                        DVLC                                                HMFC               
 

 
  LARC                                         LAP                                         CB                                                   CRED 
 

 
 
 
 
 
A)  Has correct identity been established by Receptionist/MEA?                              Yes                  No                  N/A 
 
 
                 If ‘No’ or ‘N/A’ complete B         
 
 

 
 
 
B)  Has Examining Doctor been able to establish correct identity?                        Yes                     No                  
POID1/Version 1
Feb 2002
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  104 
 
 

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Acceptable Forms of Identification 
Atos Healthcare will accept as evidence of identity one of the following: 
Type of Identity 
 
 
 
 
 
 
 
   Code 
 
Claimant’s 
own 
passport 
      PP 
 
European 
Community 
identity 
card 
     ECID 
  Standard Acknowledgement (for those seeking asylum in UK) 
 
SAL 
Alternatively, Atos Healthcare will accept any three of the following documents as 
proof of identity:
 
  Birth certificate 
 
 
 
 
 
 
 
BC 
 
Marriage 
certificate 
       
 MC 
  Travel pass 
 
 
 
 
 
 
 
TP 
  Form GV3 (one way travel document issued by UK embassies abroad) 
GV3 
 
Local 
Authority 
rent 
card 
      LARC 
  Certificate of identity issued by the Home Office to the claimant 
    
HOID 
  Forms issued by the Home Office to the claimant 
 
 
 
HODOC 
 
Police 
registration 
certificate      PRC 
 
Full 
driving 
licence 
       DVLC 
 
Life 
assurance 
policy 
      LAP 
 
Divorce/annulment 
papers 
      DP 
 
Recent 
wage 
slip 
       WS 
 
Trade 
union 
membership 
card 
     TU 
 
Adoption 
certificate 
       
 
 
 
AC 
 
Cheque 
book 
       CB 
 
Cheque 
guarantee 
card 
      CGC 
 
Bank 
statements 
       BANK 
 
Building 
society 
pass 
book 
      BSOCY 
  Paid household bills in the name of the claimant 
 
 
 
BILLS 
  Certificate of employment in Her 
Majesty’s 
Forces 
   HMFC 
 
Store 
or 
credit 
cards       CRED 
 
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  105 
 
 

Medical Services 
MEDICAL SERVICES
PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS
[Title] [Claimant Name]
[Address 1]
Reference: AB 123456 C
[Address 2]
[Address 3]
Telephone: (####) ### ####
[Postcode]
[Date]
Dear [Title] [Claimant Surname]
Re: Request for disclosure of information to your General Practitioner
Your claim/appeal for benefit has been referred to Medical Services by the Department of Work and Pensions
(DWP) for medical advice.  Whilst reviewing your claim to benefit medical findings  have come to light within the
documentary evidence of which your General Practitioner (GP) may be unaware and I would be grateful if you
would sign the declaration below in order that Medical Services can release this information to him/her.
The nature of the information that we wish to communicate to your GP is as follows:
I would also recommend you contact your GP for advice as soon as possible after returning your consent.
Please note that it is necessary for Medical Services to have your consent before we can proceed to release
information to your GP.  If consent has not been received within five days from the issue of this letter Medical
Services will contact you by telephone on this matter.
Please find enclosed a stamped address envelope.
Yours sincerely,
Medical Adviser
Claimant Consent:
I confirm that the doctor has provided the reasons for the release of information to my GP and I *give consent / *do not give
consent 
to the release of that information. (* delete as appropriate)
Signed:
(claimant)
Date:              /                /
Name:
UE2 10/01
 
Guidance for Examining Health Care Professionals 
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Page  106 
 
 

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Appendix G - Unexpected Findings Process Map 
Medical Examination 
 
All benefits 
Unexpected 
DV or Session 
 
Yes
Findings 
 
Process Map 
Unexpected 
No
Follow Normal 
 
Findings? 
Examination 
(Pg 1) 
Procedure 
 
Yes
 
 
 
Severe enough for 
No
 
immediate action?
 
 
Yes
 
 
Issue claimant with a 
hosp  ital referral letter 
Yes 
Immediate 
Complete remainder 
de tailing clinical 
of UE1 (Rev) 
Hospital
  findings 
 
No 
 
 
Sign & Date UE1 
Telephone claimant’s 
 
(Rev) 
GP to inform them of 
 
the findings 
 
 
 
 
Harmful 
Record details of 
Information 
 
conversation on 
 
UE1 (Rev) 
 
 
 
Annotate UE1 (Rev) 
No
 
“HARMFUL 
INFORMATION” 
 
 
 
 
Contact claimant’s  
 
Session 
GP by telephone 
No
Examination 
 
 to inform them of findings
 
 
 
Complete UE1 (Rev) 
Pass completed form 
 
and attach to front  
to MEA/Receptionist 
 
of file ensuring 
(see separate process 
 
it is clearly visible
Map for DVs) 
 
DV 
Sessions
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  107 
 
 

Medical Services 
 
DV Sessions
 
Unexpected
 
 
Findings 
 
Process Map
 
Return file to 
MEA Action: 
 
appropriate section 
Make 3 copies of 
(Pg 2) 
 
at the MSC 
UE1 (Rev) 
 
 
 
MSC Action: 
 
Make 3 copies of 
 
Claimant’s GP fax 
UE1(Rev) 
No 
 
number known 
 
 
 
Yes
 
MSC Action 
 
Fax and/or post a 
MEA Action: 
MEA action 
  copy of UE1 (Rev) to 
Fax a copy of UE1 (Rev) to 
phone call to GP 
 
claimant’s GP 
claimant’s GP 
to determine 
 
fax number 
 
 
 
MSC Action: 
MEA Action: 
 
Place a copy of 
Post a copy of the UE1 (Rev) 
to the claimant’s 
  UE1 (Rev) in claimant’s 
GP 
 
file 
 
 
 
MEA Action: 
 
Place a copy of UE1 (Rev) in 
claimant’s file 
 
 
 
 
MEA Action: 
 
Issue copy of 
 
UE1 (Rev) to CSD 
 
 
 
 
MSC Action: 
 
Place a copy of 
 
UE1 (Rev) in the Drs 
 
personal file 
 
(retained for min 10 years)
 
 
 
MSC Action: 
 
Place a copy of  
 
UE1 (Rev) in the CSD 
file 
(retained for min 10 years)
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  108 
 
 

Medical Services 
Appendix H - Taking of Notes during an 
Examination by Claimant or Companion 

 
 
“'Where notes are taken by you, we consider it of assistance to both myself, as 
the Examining Health Care Professional, and yourself to point out the 
following: 
 
1.   It is your right to take notes for your own use and benefit.  
2.  The notes will not be included in the Report I make save for the fact that notes 
were taken and further, they are not accepted by myself or the DWP as an 
official record of this examination. 
3.  If the notes are subsequently produced at any time for any purpose, such as 
part of an  appeal process, I the Examining Health Care Professional, my 
employer and the Dept of Work and Pensions reserve all rights to challenge 
anything in the notes in the event we are asked to comment on the content of 
the notes at a future time 
4.  You are free to use your notes as you choose but if you chose to publicise the 
notes (other than in connection with correspondence with the DWP or under 
any appeal procedure) I would ask that you do not publicise my name. “ 
 
 
 
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  113 
 
 

Medical Services 
Appendix I - DLA in Children 
 
1. Introduction 
1.1 
What follows is a summary of a consultation paper prepared by the Disability 
Living Allowance Advisory Board , which was commissioned to consider the 
following issues: 
(i) 
The way in which children make the transition to independent walking 
(based on the physical aspects of walking), concentrating on the age at 
which a normal child will make this transition and describing the range of 
expectations in terms of the age at which this transition will be made. 
(ii) 
The age at which we should expect a child to be independently mobile 
without guidance and supervision outdoors, and the characteristics of 
children who fail to achieve this particular milestone (taking account of 
physical/mental problems). 
(iii)  The characteristics of children who will fail to make either of the transitions, 
including the prognosis for independent walking for those who fail to make 
the transition. 
2. 
The Transition to Independent Walking 
2.1 
There are a number of ways in which normal children make the transition from 
immobility to independent walking.  Most children begin to crawl some time 
before walking.  They then begin to pull themselves up and move around, holding 
on to furniture, or on to an adult's hand, before taking their first independent 
steps.  Once this has occurred there is a very rapid increase in walking ability, as 
the child first becomes very mobile within the home and then outdoors.   
 
For children who crawl, the range of ages at which they first were able to take 10 
steps is around 10 - 18½ months, with a median age at about 13½ months.  
About 5% of normal children do not crawl before they walk.  A few appear to just 
stand at around 10-11 months, having made no previous effort to move around.  
Some get around by rolling over and over, while others creep on their tummies in 
a form of "commando crawl". 
2.2 
A small group of children get around by bottom shuffling, hitching or scooting in 
which the child sits on the floor and slides along on one or both buttocks, by 
pulling on the floor with one or both flexed legs.  These children have a lower 
muscle tone and tend to walk at a later age than do children who crawl.  There is 
often a similar history in siblings and other family members.  However, there is 
nothing to suggest that these children are in any way abnormal and some appear 
to excel in activities where exceptional suppleness is an advantage.  In any 
event, only about 3% of such children are not walking by the age of 30 months, 
which means that only about 15 children per 10,000 in the general populations 
(i.e. 0.15%) have failed to reach this milestone by this age. 
 
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2.3 
All these observations are supported by the findings from the 1958 National 
Childhood Development Study which followed up a cohort of around 15,000 
children who were born in April of that year.  At 18 months, all but 4.3% of 
children were walking independently, with the proportion of boys who were not 
walking being rather greater than girls (4.9% v. 3.6%).  Unfortunately, later 
studies of this type did not collect similar data on walking, but there is no reason 
to believe that the situation has changed significantly with the passage of time. 
2.4 
By the age of 2½ years, the very great majority of normal children will be walking 
independently. There is a difference between a child's first few hesitant steps and 
the development of useful walking ability.  However, for most children, once the 
first steps have been taken there is a very rapid increase in mobility.  At this age 
it is reasonably certain that all children will be able to walk unless they have a 
disability which affects their walking. 
3. 
The Transition to Independent Mobility (without guidance and supervision) 
3.1 
In many ways, the age at which children can be allowed to go out unsupervised is 
determined by external and social factors.  For example, there is a belief amongst 
many parents that the world is not such a safe place as when they were growing 
up. Having said that, parental attitudes do vary considerably on the age at which 
children are allowed out alone.  In addition, a child who lives, for example, on a 
quiet road in a small housing estate is likely to be allowed out earlier than one 
who lives on a busy main road.   
 
3.2 
Children will generally be allowed to play outdoors in a garden from about the 
age of two years.  They will be able to cope with an uneven surface and can go 
up and down low steps two feet at a time.  They will not be safe in the presence 
of ponds of places where they may fall from heights.  Supervision in any event 
will need to be frequent but not necessarily continual.  From the age of about 3 
years, most children can run and jump.  They might walk around a supermarket, 
or for a similar distance outdoors, with a parent holding hands, using reins, or 
supervising very closely.  Longer distances outdoors will be travelled in a normal 
pushchair or buggy. 
3.3 
By the age of 4 years children will normally have dispensed with the use of a 
pushchair and will walk to the local shops or playgroup (e.g. distances of up to 
half a mile or so) in the company of an adult.  During the primary school years 
there is a process during which the child's outdoor mobility becomes 
progressively greater and the level of adult supervision becomes progressively 
less.  The speed and pattern of this progression is clearly influenced by many of 
the external factors mentioned above.  In any event, it is advisable for supervision 
to be present when crossing main roads in all children up to the age of about 11 
years. 
4. 
The Characteristics of Children Who Fail to Make the Transition to 
Independent Walking or Unsupervised Mobility 

 
4.1 There are a large number of groups of children who would fail to walk by the age of 30 
months.  From these, we can identify three groups who would account for the majority 
of children within this category.  These are:- 
 
 
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Medical Services 
4.2  

Children with severe learning disabilities, with a prevalence of around 1:1000. 

Children with the most severe forms of autism, with a prevalence of around    
4:10,000 (although there will be a considerable overlap between this group 
and those with severe learning disabilities). 

Children with severe cerebral palsy, with a prevalence of about 1:1600. 
 
 
It should be noted that the prevalances quoted are estimates of the number of 
children who will have failed to walk by 30 months and not the overall prevalence 
of the particular condition.  It should also be noted that two of the categories 
relate to mental rather than physical disabilities, but in many of these, a physical 
cause for the mental disability will be evident.  Finally, it is also important that 
particularly at this end of the severity spectrum there will be an overlap between 
individuals in each of these groups. 
 
4.2 
All other relevant groups are rare and include:- 
  Other neurological disorders 
-  Duchenne Muscular Dystrophy (although many will be walking by 30 
months, only to deteriorate later);   
-  Spinal muscular atrophy; 
- Congenital myopathies; 
- Spina bifida; 
- Head injury; 
- Encephalitis/meningitis; 
-  Spinal cord injury. 
  Limb Defects (some of which can be surgically corrected). 
 Brittle 
bone 
disease. 
 Arthritis. 
  Cardiac and respiratory disorders - particularly broncho-pulmonary dysplasia, 
but also in the most severely affected children with more common 
cardiorespiratory children e.g. congenital heart disease and asthma. 
  Sensory impairments - blindness, deafness and with particular problems with 
those children who are deaf/blind. 
 
Making precise estimates of numbers is clearly difficult, but there would perhaps 
be about 4000 children in the groups discussed above who would fail to walk 
between the age of 30 months and their fifth birthday.   
4.3 
In considering the question of prognosis it is important to note, that in many such 
children we are dealing with developmental delay rather than a permanent 
impairment in walking ability and consequently an improvement should be 
expected in a high proportion - particularly in those children with severe learning 
disabilities or autism.  The position with those with severe cerebral palsy, where 
problems of lower limb spasticity remain may be different, so that despite any 
improvement brought about by the development process, training or therapy, 
severe difficulties with walking are likely to remain.   
Guidance for Examining Health Care Professionals 
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Medical Services 
 
Again making precise estimates of numbers is difficult, but a reasonable 
assumption would be that 80% of children across all groups are likely to be 
walking by the age of 4 years.   
4.4 
The question of independent mobility without guidance and supervision in 
disabled children is not especially relevant to this particular discussion, in that a 
high level of supervision is required by all children below the age of five years.  
There will be some children, for example, with learning disabilities and sensory 
impairments who will fail to walk physically by the age of 30 months, but then, as 
this ability develops, will require substantially more guidance and supervision 
than normal throughout the childhood years.  Those who would currently qualify 
for the higher rate mobility component because of severe mental impairment 
under the current rules need special mention.  These are likely to be amongst 
those with severe learning disabilities mentioned in paragraph 4.1 above.  Clearly 
however they do develop the physical ability to walk, from which point the 
particularly intense supervision needs which are characteristic of the group 
become apparent. 
 
 
 
 
 
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  117 
 
 

 
 

Medical Services 
Observation Form 
Please photocopy this page and use it for any comments and observations on 
this document, its contents, or layout, or your experience of using it.  If you are 
aware of other standards to which this document should refer, or a better 
standard, you are requested to indicate this on the form.  Your comments will 
be taken into account at the next scheduled review. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Name of sender: 
________________________ Date: _____________ 
 
Location and telephone number: ____________________________________ 
 
Please return this form to:      Angie Rhodes 
                                    
Training and Development Co-ordinator 
    Atos 
Healthcare 
    3300 
Solihull 
Parkway 
    Birmingham 
Business 
Park 
    Birmingham 
B37 7YQ
Guidance for Examining Health Care Professionals 
9 Final 
MED-S2/EHCP~0010 
Page  118