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GUIDANCE FOR DOCTORS AND NURSES COMPLETING BENEFITS
ASSESSMENT UNDER SPECIAL RULES IN SCOTLAND (BASRiS) FORM
FOR TERMINAL ILLNESS v1.0
ADVICE FROM THE CHIEF MEDICAL OFFICER
THE SCOTTISH GOVERNMENT
July 2021
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GUIDANCE FOR DOCTORS AND NURSES COMPLETING BENEFITS ASSESSMENT UNDER
SPECIAL RULES IN SCOTLAND (BASRiS) FORM FOR TERMINAL ILLNESS
Contents
1. EXECUTIVE SUMMARY .................................................................................................................... 3
2. FLOW CHART FOR ELIGIBILITY FOR BASRiS FORM COMPLETION ................................................... 6
3. BACKGROUND ................................................................................................................................. 8
4. LEGISLATION .................................................................................................................................... 9
5. AIM .................................................................................................................................................. 9
6. BASRiS PURPOSE AND PRINCIPLES .................................................................................................. 9
7. CLINICAL ASSESSMENT OF TERMINAL ILLNESS ............................................................................. 10
8. FACTUAL INFORMATION THAT MUST BE INCLUDED .................................................................... 12
9. BABIES, CHILDREN AND YOUNG PEOPLE ...................................................................................... 13
10. ELIGIBILITY TO COMPLETE THE FORM .......................................................................................... 14
11. COMMUNICATION AND CONSULTATION WITH OTHERS (INCLUDING CARERS) .......................... 15
ANNEX A ............................................................................................................................................ 17
1. PROFESSIONAL RESPONSIBILITIES ................................................................................................. 17
2. TIME TO RESPOND AND RETURN THE FORM TO SOCIAL SECURITY SCOTLAND ........................... 17
3. CONSENT ....................................................................................................................................... 18
4. ACCESS TO THE COMPLETED FORM BY INDIVIDUAL (PATIENT) OR LEGAL REPRESENTATIVE ...... 20
5. RELEASE OF INFORMATION TO SOCIAL SECURITY SCOTLAND - WHO USES THE INFORMATION?
HOW WILL THE INFORMATION BE USED? WHO IS RESPONSIBLE FOR THE FINAL DECISION? ..... 20
6. APPEALS BY APPLICANT REGARDING DECISION MADE BY SOCIAL SECURITY SCOTLAND ............ 21
7. HARMFUL INFORMATION ............................................................................................................. 21
8. EMBARRASSING INFORMATION ................................................................................................... 23
9. REHABILITATION OF OFFENDERS ACT ........................................................................................... 23
10. PROCESS FOR OBTAINING BLANK BASRiS FORMS AND SENDING COMPLETED FORMS TO SOCIAL
SECURITY SCOTLAND ..................................................................................................................... 23
11. CLAIMING FOR A FEE FOR COMPLETION OF A BASRiS FORM ....................................................... 23
ANNEX B - MATRIX TO SUPPORT THE CLINICAL JUDGEMENT PROCESS ........................................... 24
ANNEX C - WORKED EXAMPLES (ADULTS, BABIES, CHILDREN AND YOUNG PEOPLE) ...................... 30
ANNEX D - BENEFITS ASSESSMENT UNDER SPECIAL RULES IN SCOTLAND (BASRiS) FORM ............ 38
ANNEX E - CURRENT BENEFITS DEVOLVED TO SCOTLAND ............................................................... 42
ANNEX F - DS 1500 FORM ................................................................................................................. 44
ANNEX G - THE SCOTTISH SOCIAL SECURITY PRINICIPLES ................................................................ 45
ANNEX H – FURTHER SUPPORTING INFORMATION ......................................................................... 47
ANNEX I – BASRiS FEE PAYMENT FORM ........................................................................................... 49
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1. EXECUTIVE SUMMARY
Following the Scotland Act 2016, three disability benefits have been devolved to
Scotland and will become the responsibility of Scottish Ministers. These benefits are
Child Disability Living Allowance (DLA Child), Personal Independence Payment (PIP)
and Attendance Allowance (AA). The new Scottish replacements of these 3 benefits
will be administered by Social Security Scotland with different rules. They will be
called Child Disability Payment, Adult Disability Payment and Pension Age Disability
Payment. Other benefits, such as Universal Credit, have not been devolved and
continue to be administered on a UK basis, by the Department for Work and Pensions
(DWP), following existing rules and definitions.
People of all ages who live in Scotland with terminal illness are able to apply for
disability benefits under special rules resulting in the fast tracking of their application
and higher rates of assistance. This guidance sets out the new rules for accessing
those Scottish replacements of the 3 disability benefits where the potential recipient is
terminally ill (Benefits Assessment under Special Rules in Scotland (BASRiS)) using
a new definition of terminal illness for social security purposes.
This guidance provides a framework to support those making a clinical judgement
about terminal illness i.e. doctors and nurses who provide care for people towards the
end of life in a professional capacity. The guidance is also relevant to others with an
interest or involvement in the care of people who may be approaching the end of life
and/or involved in advising on social security benefits. It will also be of interest and
relevance to people who are themselves approaching the end of life, plus their family
and carers.
New Scottish legislation changes the definitions and rules surrounding terminal illness
for the purpose of access to the devolved benefits. This means that there will be no
limit set on how long a patient has left to live before their condition is considered
“terminal”.
The terminal illness definition that the Scottish Ministers use when making Disability
Assistance Regulations under the Social Security (Scotland) Act 2018 is:
An individual is to be regarded as having a terminal illness for the purpose of
determining entitlement to disability assistance if, having had regard to the (Chief
Medical Officer’s (CMO) guidance), it is the clinical judgement of an appropriate
healthcare professional that the individual has a progressive disease that can
reasonably be expected to cause the individual’s death.
An appropriate healthcare professional is defined as a registered medical practitioner
or registered nurse who meets the requirements set out in the regulations.
This guidance supports clinicians to interpret and apply this definition consistently.
To meet the definition the individual should have an illness
a) that is advanced and progressive or with risk of sudden death, AND;
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b) that is not amenable to curative treatment, or treatment is refused or declined by
the patient for any reason, AND;
c) that is leading to an increased need for additional care and support.
Notable features of this definition of terminal illness, which are different from some
other existing definitions, are:
o It is based on a clinical judgement, using a range of largely clinical
indicators.
o There is no requirement to make a prognostic judgement about how long
somebody will live.
o There is no requirement to assess individual care needs.
o It goes beyond cancer to include all diseases and conditions that are judged
to be terminal. Examples include: organ failure (respiratory disease, heart
and vascular diseases, kidney disease, liver disease); neurological
diseases (Parkinson’s disease, Motor Neurone Disease, Multiple Sclerosis);
Stroke; Frailty with one or more co-morbid diseases; Dementia; rare
diseases; combinations of diseases with conditions.
o It applies to all irrespective of criteria such as age and residency status,
provided they live in Scotland or fall into one of the statutory exceptions from
the requirement to live in Scotland.
There are many diseases, which may lead to a patient’s death in the future such as
diabetes or COPD but where the diseases are not at a stage that means the patient
requires fast tracked benefits. This guidance is not intended for such cases.
The form to certify that a patient is terminally ill, enabling them to apply for benefits
under special rules is included in this guidance. This form replaces the DS 1500 for
the Scottish replacement of benefits listed above that have been devolved to Scotland.
Those already on DS 1500 do not require a BASRiS form to be completed. Their
entitlement will be automatically recognised and transferred to the benefits under the
Scottish system.
Section 2 is a flowchart illustrating the different processes through which an individual
presenting with progressive disease may pass, depending on their circumstances and
whether or not they meet the new definition. It should be remembered that a patient
who is not eligible under the special rules is still able to apply for benefits and undergo
assessment in the usual way.
Section 3 is a table summarising the differences between the current UK rules for
terminal illness benefits (“DS1500”) and the new approach to disability benefits which
have been devolved (Benefits Assessment under Special Rules in Scotland
(BASRiS)).
Sections 4-6 provide more detail on the aim, purpose and principles of BASRiS.
Section 7 is a key section providing more detail on how doctors and nurses must
approach the clinical assessment of terminal illness.
Section 8 lists the factual information which will be required when documenting a
clinical assessment of terminal illness on a BASRiS form.
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Section 9 provides information on how to apply this guidance in the case of babies,
children and young people.
Section 10 sets out which doctors and nurses are eligible to make a clinical
assessment of terminal illness for the purpose of BASRiS.
Section 11 provides guidance on handling the sensitive communications with
individuals and their families/carers which is required throughout the BASRiS process.
There are nine annexes (A to I) which provide a range of background information and
practical resources. These are signposted at relevant points in the body of the
guidance. Annex B contains resources designed to help in reaching a clinical
judgement as to whether an individual meets the definition of terminal illness. Annex
C contains some case-based worked examples involving adults and children of how
the definition would apply to different individuals.
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2. FLOW CHART FOR ELIGIBILITY FOR BASRiS FORM COMPLETION
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DIFFERENCES BETWEEN THE REQUIREMENTS FOR BASRiS AND DS 1500
FORMS
The Table below provides the differences between the 2 systems
Requirements
BASRiS (when Scotland’s
replacement benefits commence)
DS 1500 (current UK
rules used by DWP)
Definition of
terminal Illness
It is the clinical judgement of an
appropriate healthcare professional
that the individual has a progressive
disease that can reasonably be
expected to cause the individual’s
death.
A progressive disease
where death as a
consequence of that
disease can reasonably
be expected within 6
months.
Time limit
No time limit
Likely to die within 6
months
Qualifying
period
None
None
Review period
No review period
Review after 3 years
Benefits
Automatic award to the highest rate
of assistance that they are entitled
to: Child Disability Payment Adult
Disability Payment and Pension Age
Disability Payment
Automatic award of the
highest rate for care only
under the relevant benefit
at present: PIP, DLA and
AA as well as
Employment Support
Allowance (ESA) and
Universal Credit (UC).
Completed by
Registered Medical Practitioners and
Registered Nurses
Medical Practitioners or
specified Specialist
Nurses
Interaction
between
BASRiS and
DS 1500
Individuals in receipt of BASRiS will
need to meet the DWP definition if
claiming ESA or UC.
Where a client already has a
BASRiS form the DWP can use the
information, as part of their suite of
medical information, to determine
whether the individual meets their
definition and is therefore eligible for
the reserved benefit under the DWP
rules.
Individuals already In
receipt of DS1500 will be
automatically eligible
under BASRiS.
Definitions
BASRiS
The terminal illness definition under the Social Security (Scotland) Act 2018 is:
“An individual is to be regarded as having a terminal illness for the purpose of
determining entitlement to disability assistance if, having had regard to the (Chief
Medical Officer’s (CMO) guidance), it is the clinical judgement of an appropriate
healthcare professional that the individual has a progressive disease that can
reasonably be expected to cause the individual’s death.”
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DS 1500
Terminal illness for the purposes of DS 1500 is defined in UK Social Security
legislation as:
“a progressive disease where death as a consequence of that disease can reasonably
be expected within 6 months”.
3. BACKGROUND
The Scotland Act 2016 gave Scotland new powers relating to social security, including
responsibility over certain benefits (Annex E).
These powers have been used to create a Scottish Social Security system based on
dignity, fairness and respect, which will help to support those who need it, when they
need it. This includes improving benefits for disabled people and people with ill health,
as well as confirming that on the infrequent occasions that assessments are required,
they will not be carried out by the private sector.
The Social Security (Scotland) Act 2018 confirms that there will be no limit set on how
long a patient has left to live before their condition is considered "terminal" (Annex G).
It is for Registered Medical Practitioners (RMPs) and Registered Nurses (RNs) to use
their clinical judgement to decide whether the illness is terminal, enabling their patient
to apply for disability assistance under special rules, where appropriate. This will allow
the patient’s claim for disability assistance to be processed differently, under special
rules, resulting in the fast tracking of their application and entitlement to the highest
rates of the components (care and/or mobility) relevant to the benefit.
In this context, it is expected that the RMPs and RNs involved in the diagnosis of
terminal illness:
must have appropriate skills, knowledge and experience to undertake the
role and;
must be involved with the diagnosis and / or care of the patient and;
must be acting in their professional capacity and;
must work in accordance with a clinical governance framework and the
requirements of your employers and/or contractual arrangements and;
must hold current registration with the General Medical Council or the Nursing
and Midwifery Council.
(More information can be found in the online Frequently Asked Questions
https://www.socialsecurity.gov.scot/guidance-resources/guidance/special-rules-
for-terminal-illness-frequently-asked-questions
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)
The evidence you provide through BASRiS will support Social Security Scotland to
make a decision about entitlement to disability benefits under special rules.
Your responsibility is to use your clinical judgement to diagnose whether you consider
the individual’s condition to be terminal, according to the new definition, i.e. An
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https://www.socialsecurity.gov.scot/guidance-resources/guidance/special-rules-for-terminal-illness-
frequently-asked-questions
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individual is to be regarded as having a terminal illness for the purpose of determining
entitlement to disability assistance if, (having had regard to this CMO guidance), it is
the clinical judgement of an appropriate healthcare professional that the individual has
a progressive disease that can reasonably be expected to cause the individual’s death.
4. LEGISLATION
Special Rules in Scotland has 4 components:
There is no qualifying period. An individual is not required to have the condition
for any length of time before they are eligible under special rules.
Once verification has been given that the person is considered to have a
terminal illness, for the purpose of entitlement to disability assistance, there is
no requirement for an individual to undergo any further assessment to establish
that a person has a terminal illness
Awards will be calculated, at the latest, from the date of application by the
patient
Patients who qualify under special rules will be automatically entitled to the
maximum amount of award of the benefit they are entitled to
The Social Security Principles, with the underpinning legislation for the special rules
are set out in (Annex G).
5. AIM
The aim of this guidance is to enable RMPs and RNs to use their clinical judgement
to determine whether their patient is terminally ill, for the purpose of entitlement to
disability assistance. Through the completion of a BASRiS form, your evidence will
support your patient’s application for disability assistance to be processed differently,
under special rules. Social Security Scotland may require further information from
RMPs and RNs signing the BASRiS form, where the content is not explicit or legible
enough. With this in mind, the document provides guidance to support and assist you
in making these difficult decisions. It will also enable you to explain and provide a
clear rationale for making those decisions made on clinical grounds, if patient, carers,
family, or others have any queries.
The process for diagnosing terminal illness for the purposes of applying for Scottish
equivalents of disability assistance, as laid out in this Guidance, applies to all –
irrespective of criteria such as age and residency status, provided they live in Scotland
(or fall into one of the statutory exceptions from the requirement to live in Scotland).
This includes people with no fixed address or who are homeless. The only exception
is those who are subject to immigration status. However, there is no requirement for
RMPs and RNs to determine these factors, as these checks will be undertaken by
Social Security Scotland.
6. BASRiS PURPOSE AND PRINCIPLES
The purpose of the BASRiS form is to provide evidence about whether, in your clinical
judgement, the condition is “terminal” and therefore the individual requires expedited
access to disability assistance. This will provide evidence of eligibility to disability
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assistance under special rules. It is not for you to assess the type of disability benefit
that your patient is eligible for or undertake a formal functional assessment. In addition,
the purpose of the clinical assessment for these benefits, in this instance, is not to
provide care. However, those patients who are eligible for these benefits could also
be in receipt of other care and support services or signposted to these services where
appropriate.
By recording your clinical judgement on the BASRiS form, your patient will be able to
access much needed additional support at the time of their greatest need. The
disability benefits are likely to enable them to have the quality of life that they seek, for
example: meeting additional costs of care or travel, and providing the ability to visit
places or people that they hold dear.
Principles:
The process should be fair and seen to be fair and transparent to the RMPs
RNs, other professionals and the public.
The process should support an individual when they are terminally ill (see
definition set out in Section 7), reducing unnecessary distress wherever
possible. It may also improve the quality of life of carers and those close to the
individual.
Receipt of the new Scottish benefits Child Disability Payment, Adult Disability
Payment and Pension Age Disability Payment, may enable access to relevant
housing, and health and social care support for the individual. The benefits
may assist in the access to benefits for the patient’s carers.
The process may also require an application by the individual or a third party
acting on their behalf for the relevant disability assistance, if this is not already
in place.
The clinical judgement of terminal illness enables the provision of assistance
for the added costs of the disability. The benefit is not “income support” and is
not means tested.
The process of making the clinical judgement should be consistent with this
guidance, despite the decisions varying according to individual circumstances.
Social Security Scotland may require further information from RMPs and RNs
signing the BASRiS form, where the content is not explicit or legible enough to
process the application.
Even if the decision that the patient is not deemed eligible for the fast tracking
of benefits assistance under special rules, they can be assessed by Social
Security Scotland using the standard application route.
7. CLINICAL ASSESSMENT OF TERMINAL ILLNESS
The Social Security (Scotland) Act 2018 states that regulations are to make clear that:
an individual is to be regarded as having a terminal illness for the purpose of
determining entitlement to disability assistance if, (having had regard to the CMO
guidance), it is the clinical judgement of an appropriate healthcare professional that
the individual has a progressive disease that can reasonably be expected to cause the
individual’s death.
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It is important to note that this definition goes beyond cancer to include all diseases,
including those associated with other conditions, that are judged to be terminal by an
RMP and RN. Examples include: organ failure (respiratory disease, heart and vascular
diseases, kidney disease, liver disease); neurological diseases (Parkinson’s disease,
Motor Neurone Disease, Multiple Sclerosis); Stroke; Frailty with one or more co-
morbid diseases/conditions; Dementia; and rare conditions or diseases. This list is
not exhaustive. In addition, individuals’ eligibility for BASRiS also could be established
based on a combination of diseases with conditions.
Your patient should display all of the following indicators:
a) an illness that is advanced and progressive, or with risk of sudden death, AND;
b) that is not amenable to curative treatment, or treatment is refused or declined by
the patient for any reason, AND;
c) that is leading to an increased need for additional care and support.
There are a number of tools, which can be used to assist you in the process of making
your clinical assessment of terminal illness, and these are given in Annex B.
There are many diseases, which may lead to a patient’s death in the future such as
diabetes or COPD but where the diseases are not at a stage that means the patient
requires access to disability assistance under special rules for terminal illness. This
guidance is not intended for such cases because expedited access to benefits is
unnecessary.
Accurately predicting when someone may die is known to be difficult and imprecise.
Estimating prognosis is also recognised to be challenging. The clinical judgement
becomes more challenging the further ahead you are asked to predict a patient’s
death.
Certainty is not required.
A GP on average will be involved in approximately 20 deaths/2000 patients/year. Of
these, 2 are likely to be Sudden Unexpected deaths; around 5 deaths will be due to
Cancer; around 6 deaths will be due to Organ Failure; and around 7 deaths will be due
to Dementia, Frailty, and Decline (Murray SA & Sheikh A. Palliative Care Beyond
Cancer: Care for all at the end of life. BMJ 2008;336:958-9).
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The clinical judgement
that you are being asked to make is about the patient’s overall condition, and from a
basket of indicators. At the time of making the decision, in addition to the diagnosis of
the terminal disease, you should also take account of the wider circumstances
affecting their ability to cope with undertaking activities of daily living.
The assessment and judgement should be made on clinical grounds and be based on
suitable clinical expertise and opinion, as well as the experience of your patient and
their carers or family. Any additional information gathered about the patient’s condition
and circumstances, may be of assistance to you and other colleagues in assessing
and planning to meet other health and care needs. The information you gather may
2
https://www.bmj.com/content/336/7650/958.1.short
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also help you to provide a clear rationale for making the decision for or against
eligibility for BASRiS, in the event of any queries or disagreement from the patient,
carers, family, and/or others.
Some tools to help you to improve the consistency in the process of making the clinical
judgement of terminal illness are attached in Annex B.
Social Security Scotland may seek information from the RMP and RN signing the
BASRiS form, depending on explicitness, legibility and clarity of the content.
Some worked examples are included in Annex C.
An information leaflet for professionals and a similar leaflet for individuals who are
terminally ill and those who support them have been developed by Social Security
Scotland with input from stakeholders, which can be shared widely. Links to these can
be found in Annex H.
The differences between DWP criteria for DS 1500 and the BASRiS will require to be
handled sensitively, particularly if a patient is accessing both devolved and reserved
benefits. The differences between BASRiS and DS 1500 are laid out in Section 2.
It is important that you are aware that there are other legislative definitions of terminal
illness (e.g. Carers (Scotland) Act 2016.). However, these should not be used to
assess eligibility for BASRiS
8. FACTUAL INFORMATION THAT MUST BE INCLUDED
The BASRiS form is based on factual information, and should contain details of:
Community Health Index (CHI) number of the individual
Your General Medical Council (GMC) or Nursing and Midwifery Council (NMC)
number and official work contact details including telephone number (not your
personal number)
Affirmation that you are providing the information to the best of your knowledge
and belief and that you have been professionally involved in the diagnosis and/
or care of the patient and had access to the relevant records. This includes
doctors or nurses taking over the care of the patient.
Diagnosis of the main disease/s and other relevant associated conditions (in
some cases there may be no formal explicit diagnosis e.g. you may have to
record the diagnosis as “neurological disease” without specifying which
neurological disease in babies, children, young people or adults)
Clinical features of the disease (causing the terminal illness) which
indicate a severe progressive condition (examination findings and results
of investigations including staging if appropriate)
Relevant treatment including response and planned
treatment/interventions that may significantly alter the prognosis
Whether the patient is aware of their condition and/or prognosis
If unaware, the name and address of the patient’s legal representative
requesting the form or aware of the form being completed
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Consent from patient and/or their representative to share the information with
Social Security Scotland, and noted in the patient’s clinical records
Whether carers’ views have been taken into account
9. BABIES, CHILDREN AND YOUNG PEOPLE
This guidance is equally applicable to babies, children and young people with life
threatening or life limiting diseases or illness.
Children and young people may have particular needs. Their views, if they have
mental capacity, need to be considered alongside those of their parents, carers and
family, in accordance with the Getting it Right for Every Child (GIRFEC)
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approach.
Children and young people have rights, which should be respected. This includes
taking into account their views and respecting their confidentiality.
Appropriate language and forms of non-verbal communication should be employed,
noting that conversations with children and young people may be very challenging
when considering issues related to likely end of life care, not least, as many
professionals do not undertake these on a regular basis.
The Social Security (Scotland) Act 2018 recognises the importance of inclusive
communication. It states that:
“’communicating in an inclusive way’ means communicating in a way that ensures
individuals who have difficulty communicating (in relation to speech, language or
otherwise) can receive information and express themselves in ways that best meet
each individual’s needs.”
http://www.legislation.gov.uk/asp/2018/9/enacted
4
Identifying the best interests of babies, children and young people is often not easy,
and may be complicated by legal and ethical issues, as well as issues of consent and
capacity.
https://learning.nspcc.org.uk/research-resources/briefings/gillick-competency-and-
fraser-guidelines/
5
Child protection issues also need to be considered in the usual way, as some
individuals may be a danger to the child or young person.
The trajectory of diseases and illness in babies, children and young people, may be
different to that in adults.
3
https://www2.gov.scot/Topics/People/Young-People/gettingitright
4
http://www.legislation.gov.uk/asp/2018/9/enacted
5
https://learning.nspcc.org.uk/research-resources/briefings/gillick-competency-and-fraser-guidelines/
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Specific issues related to neonatal conditions need to be considered, such as,
following premature birth, birth injuries, the diagnoses of congenital abnormalities and
metabolic diseases.
Children and Young People may have different support mechanisms e.g. young
people may relate more to their peers.
You may wish to discuss the completion of a BASRiS form with the specialist involved
in the care of the child or young person, or another specialist in this area. A reference
point may be through discussion with colleagues at Children’s Hospices across
Scotland (CHAS): https://www.chas.org.uk/.
10. ELIGIBILITY TO COMPLETE THE FORM
An RMP or RN who meets all 5 criteria can complete the BASRiS form. The RMP or
RN:
must have appropriate skills, knowledge and experience to undertake the
role and;
must be involved with the diagnosis and / or care of the patient and;
must be acting in their professional capacity and;
must work in accordance with a clinical governance framework and the
requirements of your employers and/or contractual arrangements and;
must hold current registration with the General Medical Council or the Nursing
and Midwifery Council
This is in contrast to the DS 1500 form, which can be completed by certain types of
specialist nurses. Currently, the Scottish legislation only allows Registered Medical
Practitioners and Registered Nurses to take responsibility for signing the BASRiS form
for devolved benefits. Other professional groups are not eligible to sign the BASRiS
form at this stage. However, RMPs and RNs may wish to consult and seek the advice
of the wider healthcare and non-healthcare staff involved in the care and support of
the patient where relevant, in addition to seeking the views of the patient’s informal
carers, when completing the form.
This may include nurses and other clinical professionals, social workers, care workers,
housing officers and others.
On some occasions, Social Security Scotland may receive a completed form from an
applicant, stating that the application is under Special Rules for Terminal Illness
without submitting a BASRiS form. In this instance, a Social Security Scotland
(clinical) Practitioner may make telephone contact with the RMP or RN nominated on
the form by the applicant and check eligibility of their patient to receive a BASRiS
certificate. If the answer is “yes”, then the application will be processed and payment
made to the claimant Following this the RMP or RN will complete and send a BASRiS
form for their patient and keep a copy for the patient record. Social Security Scotland
would expect to receive the form within a month; if it has not been received they could
follow this up. The RMP or RN will only receive a payment if eligible to claim fees for
completion of the form, when Social Security Scotland receive a completed and signed
BASRiS form and the Fee Payment Form. If the answer is “no”, then the applicant
can choose whether to agree to Social Security Scotland processing the application
under normal rules or contact the RMP or RN to discuss their clinical condition.
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Where the individual who is terminally ill meets the residence and presence conditions
for disability assistance but is currently living in an EEA state, Switzerland or Gibraltar
then appropriate healthcare professional includes a doctor or nurse who has
equivalent qualifications to a registered medical practitioner or registered nurse, in an
EEA state, Switzerland or Gibraltar. They must meet the 5 criteria set out above with
the exception of the fifth. Instead the doctor or nurse must be a member of the
professional body equivalent to the General Medical Council or Nursing and Midwifery
Council in that EEA state, Switzerland or Gibraltar.
11. COMMUNICATION AND CONSULTATION WITH OTHERS (INCLUDING
CARERS)
Communication with other healthcare professionals
You may wish to take the opportunity to seek the views of other professional
colleagues involved in the care of the individual. You may also wish to share the
information that a BASRiS form has been completed with other relevant professional
colleagues, once completed.
Communication with your patient, carers, and family
You should raise the issue of BASRiS when appropriate, rather than wait for the
patient, their carer or family to raise it with you e.g. it would be beneficial to consider
the provision of BASRiS form at relevant interactions, such as when agreeing an
electronic Key Information Summary (eKIS) and an Anticipatory Care Plan (ACP)
recommended by the Healthcare Improvement Scotland’s Scottish Anticipatory Care
Programme.
In some cases a patient may already be aware of BASRiS and may approach the RMP
or RN, asking them for a BASRiS form.
You should have a conversation with informal and formal carers, wherever possible
and relevant e.g. where the individual or their legal representative has given
permission, and where this will assist a clinical judgement to be made without resulting
in additional unnecessary delays. Your approach should be sensitive to their needs
and beliefs. Carers and family members may be able to provide evidence and
examples of the rapidity of deterioration of the condition, which may help you to make
a decision.
Depending on what the patient already knows, it can be a difficult conversation for
clinicians and their patients, and/or family and carers. A very imprecise prediction of
prognosis may cause distress to the patient, their carers or family.
There may not be the opportunity to have several conversations over time with patients
and those close to them.
Be mindful that some patients may wish to know everything about the prognosis of
their condition and others may not want to have the conversation at all. In addition,
16
some patients may not be aware of their condition. Your approach can have a long
lasting effect on the individual and their carers and families.
Please consider the following links, which provide advice and guidance on initiating
sensitive and difficult conversations:
https://gmcuk.wordpress.com/2016/05/13/handling-difficult-conversations-ten-top-
tips/
6
http://www.sad.scot.nhs.uk/media/16017/transcript-of-discussing-dying.pdf
7
http://www.sad.scot.nhs.uk/before-death/end-of-life-care/
8
https://www.bhf.org.uk/informationsupport/publications/living-with-a-heart-
condition/difficult-conversations---talking-to-people-with-heart-failure-about-the-end-
of-life
9
https://ihub.scot/project-toolkits/anticipatory-care-planning-toolkit/anticipatory-care-
planning-toolkit/
10
http://www.ec4h.org.uk/resources/anticipatory-care-planning-in-scotland/
11
6
https://gmcuk.wordpress.com/2016/05/13/handling-difficult-conversations-ten-top-tips/
7
http://www.sad.scot.nhs.uk/media/16017/transcript-of-discussing-dying.pdf
8
http://www.sad.scot.nhs.uk/before-death/end-of-life-care/
9
Difficult Conversations | BHF
10
https://ihub.scot/project-toolkits/anticipatory-care-planning-toolkit/anticipatory-care-planning-toolkit/
11
http://www.ec4h.org.uk/resources/anticipatory-care-planning-in-scotland/
17
ANNEX A
ADDITIONAL INFORMATION (INCLUDING PARTICULAR CIRCUMSTANCES)
1. PROFESSIONAL RESPONSIBILITIES
For RMs, your actions should be in line with your professionalism required in the
GMC’s Good Medical Practice
12
e.g. you are competent, keep your knowledge and
skills up to date, you establish and maintain good relationships with patients and
colleagues, are honest and trustworthy, and act with integrity and within the law. RN
actions should be in line with the NMC Code
13
e.g. you maintain the knowledge and
skills required for safe and effective practice, communicate effectively and clearly and
show integrity in your practice. You should be alert to and address unwarranted
variation in your assessments and decisions.
You should provide the report to the best of your knowledge and belief, on the balance
of probabilities. The clinical judgement should be made by you, and supported by as
much relevant information that is available to do so. Certainty is not required.
Reflection on previous decisions may be able to support you to make the appropriate
decisions in the future.
GMC does caution doctors, that the legal requirements should not be construed in
such terms that they prevent doctors from exercising appropriate clinical judgement,
or give rise to conflicts of interest, when it comes to diagnosing and managing a
patient’s condition. For example, any interpretations likely to incentivise doctors
and/or patients to take a particular approach to the diagnosis and management of a
patient’s condition, which might not otherwise be seen as clinically appropriate, or of
no overall benefit to the wellbeing of the patient, should be avoided. NMC requires
nurses to exercise their judgement in any decision making and to uphold the values
set out in the Code and in line with the laws of the country of practice.
BMA ethical guidance
14
and NMC principles
15
and ethical guidance
16
can also help
with the consideration of relevant legal and ethical principles.
2. TIME TO RESPOND AND RETURN THE FORM TO SOCIAL SECURITY
SCOTLAND
Once you have determined that a BASRiS form should be completed, you should
complete the form promptly, with the expectation that it will be done as quickly as
possible. This may be following your own knowledge of the condition and decision, or
an assessment of the situation following a request by the individual, their carer or
another healthcare professional involved in their care. This does not have to be via a
face-to-face appointment.
12
https://www.gmc-uk.org/-/media/documents/good-medical-practice---english-20200128_pdf-
51527435.pdf?la=en&hash=DA1263358CCA88F298785FE2BD7610EB4EE9A530
13
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
14
https://www.bma.org.uk/advice/employment/ethics/ethics-a-to-z
15
https://www.rcn.org.uk/professional-development/publications/pub-006499
16
https://www.rcn.org.uk/professional-development/principles-of-nursing-practice
18
3. CONSENT
You need to seek and obtain valid informed and explicit consent from the patient
and/or their representative, to share their personal/sensitive information securely with
Social Security Scotland. You will need to keep a record of this consent as part of the
clinical records you hold for the patient.
In some cases, such as in the absence of the patient’s legal representative, you may
need to send the BASRiS form to Social Security Scotland without the explicit consent
of the patient. This would be necessary, if you believe that it is in the best interest of
the patient, as disclosing the clinical information to the patient, in your view would be
harmful to the patient (see section - 7 Harmful Information). If the BASRiS form has
been completed and sent under these circumstances, and using the legal basis under
General Data Protection Regulations (GDPR),
17
(namely that processing is necessary
in the public interest), detailed records need to be kept of the reason e.g. detriment to
mental and emotional wellbeing of the patient. However, you need to be aware that
given the European Convention on Human Rights
18
, you cannot override the express
wishes of the patient, where the patient has capacity to express them. In other words,
where such a patient has stated that they do not wish the BASRiS form to be
completed and submitted to Social Security Scotland, BASRiS form must not be
completed.
The Social Security (Scotland) Act 2018 (‘the 2018 Act’) makes provision for formal
and legal representatives to act on behalf of adults with incapacity such as:
Appointees;
Guardians;
Personal Acting Bodies;
Corporate Acting Bodies; and
Power of Attorney
However, there may be individuals who do not lack capacity but could benefit from an
appointee in certain circumstances. Some individuals may prefer and agree to another
person becoming their appointee during a very difficult time in their lives. Where
harmful information has been withheld, Social Security Scotland will inform the client
of the many ways they could be supported in their interactions with the agency and
this will include the option of having an appointee to act on their behalf.
Third party Representative
Many adults who do not fall within the definition of an adult with incapacity
19
and who
need or want help or advice can also access it from another person or organisation
(Third Party Representative) to engage with Social Security Scotland. In the
majority of circumstances it will be possible for individuals to rely on common law
agency arrangements to appoint another person to act on their behalf in their
interactions with Social Security Scotland. This policy is specific to third party
17
https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/?q=fine
18
https://www.equalityhumanrights.com/en/what-european-convention-human-rights
19
As defined in the Adults with Incapacity (Scotland) Act 2000 section 1 para 6
19
representatives and does not apply to formal representatives as listed above. This
is particularly important for patients with disabilities or conditions that make it difficult
for them to express themselves but who are not deemed to be an adult with
incapacity, or clients for whom English is not their first language and find it difficult to
communicate without an interpreter. It is important that patients who wish to do so
are able to ask a third party representative to help them conduct their business with
the Social Security Scotland, but that this is balanced with Social Security Scotland’s
obligations to protect personal information as set out in the Data Protection Act 2018.
GMC’s Guidance on Confidentiality (10c)
20
also states that you must “get the patient’s
explicit consent if identifiable information is to be disclosed for purposes other than
their own care or local clinical audit, unless the disclosure is required by law or can be
justified in the public interest.” The NMC Code
21
states that ‘a person’s right to privacy
must be respected in all aspects of their care and that information may be shared
about ongoing care or treatment as far as the law allows’.
Occasionally consent may be provided by a third party appointed to act on the patient’s
behalf, for example:
If the patient is incapable within the meaning of the Adults with Incapacity
(Scotland) Act 2000
22
, and where the individual’s estate is not being
administered by a judicial factor or other person who has authority to act on
behalf of the individual and is willing to do so e.g. an Appointee, a welfare or
financial guardian or someone with a power of attorney.
The Adult Support and Protection (Scotland) Act 2007
23
may also be relevant in
certain situations.
Children and Young People
In Scotland, the general position is that a young person 16 years and above is
presumed to have the capacity to enter into a transaction - Age of Legal Capacity
(Scotland) Act 1991
24
. However, the Act makes clear that a person under the age of
16 years will have capacity to consent to a surgical, mental or dental procedure, on
his or her own behalf, providing that the medical practitioner providing care is satisfied
that the person is capable of understanding the nature and possible consequences of
the procedure or treatment. No minimum age is set down, as the matter is based
simply on what the medical practitioner believes to be the level of understanding of the
young person. This is reflected in guidelines related to Gillick/Fraser competence
25
Parental responsibility – The British Medical Association and RCN offer advice on this,
but considerations also need to be made if both parents do not agree and specific
20
https://www.gmc-uk.org/-/media/documents/gmc-guidance-for-doctors---confidentiality-good-
practice-in-handling-patient-information----
70080105.pdf?la=en&hash=08E96AC70CEE25912CE2EA98E5AA3303EADB5D88
21
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
22
https://www.legislation.gov.uk/asp/2000/4/contents
23
https://www.legislation.gov.uk/asp/2007/10/contents
24
https://www.legislation.gov.uk/ukpga/1991/50/contents
25
https://learning.nspcc.org.uk/research-resources/briefings/gillick-competency-and-fraser-guidelines/
20
considerations need to be made when a baby, child or young person has a legal
guardian. Individuals who are “looked after and accommodated” have special
considerations and ‘parental responsibility’ may be devolved to their local authority up
to the age of 25 years.
Parental responsibility – BMA
26
Parental Responsibility p10 - RCN
27
Children and young people may have particular communication needs and may need
help to make decisions.
4. ACCESS TO THE COMPLETED FORM BY INDIVIDUAL (PATIENT) OR
LEGAL REPRESENTATIVE
The Access to Medical Reports Act 1988
28
only applies to access to reports for
insurance and employment purposes. It does not apply to the completed BASRiS
form.
However, patients have a right to request access to their clinical records, under the
Access to Health Records Act 1990
29
.
5. RELEASE OF INFORMATION TO SOCIAL SECURITY SCOTLAND - WHO
USES THE INFORMATION? HOW WILL THE INFORMATION BE USED? WHO IS
RESPONSIBLE FOR THE FINAL DECISION?
The information should only be released to Social Security Scotland, with the
knowledge and consent of the individual or their Appointee, Legal Guardian or Power
of Attorney, except where information has been withheld (see Section 7 – Harmful
Information).
Social Security Scotland Case Managers are required to consider all the available
evidence before making a decision about eligibility for disability assistance.
The medical information you provide will be considered as part of this evidence
gathering.
Decisions on disability assistance are made usually by a team in Social Security
Scotland, which include non-medical/non-clinical decision-makers. One of Social
Security Scotland’s Clinical Practitioners may contact you for clarification if your report
is not explicit enough for a decision to be made. They will not challenge your clinical
judgement in relation to the terminal nature of the disease or condition, but may need
26
https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&ved=2ahUKEwigqJrssIjeA
hUSasAKHXB_D1EQFjAGegQIBRAC&url=https%3A%2F%2Fwww.bma.org.uk%2F-
%2Fmedia%2Ffiles%2Fpdfs%2Fpractical%2520advice%2520at%2520work%2Fethics%2Fparentalre
sponsibility.pdf&usg=AOvVaw02DDWuJ2rFim_tVvt0nHlM
27
https://www.rcn.org.uk/professional-development/publications/rcn-caring-for-cyp-uk-pub-009405
28
https://www.legislation.gov.uk/ukpga/1988/28/section/1
29
https://www.legislation.gov.uk/ukpga/1990/23/contents
21
to clarify and confirm other details provided by the you (for example, in cases of
illegibility).
6. APPEALS BY APPLICANT REGARDING DECISION MADE BY SOCIAL
SECURITY SCOTLAND
Social Security Scotland will be responsible for the decision to make an award
following receipt of the BASRiS and therefore an appeal can be made against the
decision of the Case Manager on the eligibility of components of the disability
assistance but not against your clinical judgement. However, Social Security Scotland
may contact you for further information about the content of the BASRiS form to
process the application. This could be where it appears that the form has been
completed by someone who is unauthorised to do so or where it is clear that the form
has been completed without having regard to this guidance. Case Managers in Social
Security Scotland will have access to advice from a senior medical or other clinical
professionals to review the information provided in the BASRiS where needed. The
intention is to audit the data collected on the various aspects of the process in this
area e.g. to monitor unwarranted variation in the application of this guidance.
However, you need to be aware that the individual and/or their legal guardian may not
agree with your views and may ask for a second opinion from another RMP. You
should follow the usual processes for requests for a second opinion, including advice
by the GMC or NMC. You should also follow the usual processes for any issues of
indemnity cover and professional advice and support.
Where a patient is not deemed eligible for disability assistance under the special rules
i.e. BASRiS, the patient will be able to apply for disability assistance through the
standard application route, and they should be supported to do so e.g. referral to Social
Security Scotland or welfare advisers.
7. HARMFUL INFORMATION
Harmful information is anything that would be considered to cause serious harm to an
individual’s mental and/or physical health (see GMC’s Guidance on Consent
30
), if they
were to become aware of it (e.g. a diagnosis of malignancy). In practice, while
addressing the needs of a patient holistically, it is understood that in most
circumstances, serious harm to mental health may not be able to be separated from
harm to physical health and vice versa. According to GMC guidance there is a limited
exception of “serious harm” where it may be appropriate to withhold the information
form the patient. “Serious harm” means more than that the patient might become
upset. GMC guidance also states that, “if you delay sharing information necessary for
making a decision, you should let the patient know there is more to discuss and make
sure arrangements are made to share the information as soon as it’s appropriate to
do so. You must make a record of the information you still need to share, your reasons
for not sharing it now, and when it can be shared.” The information on the BASRiS
form may be withheld from a patient at that time, where that is thought to be in the
30
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent
22
patient’s best interests, but GMC Guidance advises that arrangements should be
made to share the information as soon as it is appropriate to do so.
In the context of the BASRiS form withholding harmful information is relevant if there
may be “serious harm to the physical and / or mental health of the patient or the
parent/individual with legal parental responsibilities for a child”. This information will
then not be released to the recipient by Social Security Scotland in accordance with
the Data Protection Act 2018
31
(see below) and the Social Security Administration
and Tribunal Membership Act 2020
32
.
In the highly unlikely scenario that you have withheld information from your patient’s
legal representative/appointee, it is important that you indicate this on the BASRiS
form. You are not being asked to make any additional assessment of serious mental
and / or physical harm to a legal representative. It is only where, you have withheld
the information on the BASRiS form from a legal representative/appointee of the
patient that you need to inform Social Security Scotland of this.
This will also need to be considered where a patient or their legal representative may
make a request to Social Security Scotland to access the patient’s medical records.
Social Security Scotland can only withhold information from the client when the
exemption in the Data Protection Act 2018
33
and the corresponding exemption in the
Social Security Administration and Tribunal Membership Act 2020
34
applies. This
allows information to be withheld where it is ‘likely to cause serious harm to the
physical and / or mental health of the data subject’. If you have withheld information it
is important that this is clearly noted on the BASRiS form itself.
Where Social Security Scotland have been informed on a BASRiS form that harmful
information has been withheld they will follow this up, after 3 months, by contacting
the clinician and asking them to confirm whether the information continues to be
withheld. If Social Security Scotland are given reason to believe harmful information
is no longer withheld before the 12 weeks, they will contact the clinician earlier. This
is to ensure that Social Security Scotland retains an accurate record of when harmful
information is withheld.
If your reason does not fit the criteria of “serious harm to the physical and / or mental
health of the patient, or parent/individual with legal parental responsibilities for a
child”, and they are not subject to Adults with Incapacity legislation, you will need to
seek the consent of your patient before completing and sending the BASRiS form to
Social Security Scotland.
31
https://www.legislation.gov.uk/ukpga/2018/12/schedule/3
32
Social Security Administration and Tribunal Membership (Scotland) Act 2020 (legislation.gov.uk)
33
https://www.legislation.gov.uk/ukpga/2018/12/schedule/3
34
Social Security Administration and Tribunal Membership (Scotland) Act 2020 (legislation.gov.uk)
23
8. EMBARRASSING INFORMATION
Under data protection legislation, the Data Protection Act 2018
35
, the fact that
information would simply embarrass the author, or someone else, is not taken into
account in determining whether it should be processed. Any certificates, which you
provide, should not contain inappropriate personal remarks, which cannot be
substantiated, and which you would not want your patient to see e.g. suspicions of
exaggerating or feigning.
9. REHABILITATION OF OFFENDERS ACT
To ensure compliance with the Rehabilitation of Offenders Act 1974 (Exclusions and
Exceptions) (Scotland) Order 2013 (SI 2013/50)
36
, your report should not contain any
reference to criminal convictions whether spent or not unless the information is directly
relevant to the individual’s condition. This may be relevant where, for example, a
person is due to be released/liberated from prison on compassionate grounds,
because of having a terminal illness.
10. PROCESS FOR OBTAINING BLANK BASRiS FORMS AND SENDING
COMPLETED FORMS TO SOCIAL SECURITY SCOTLAND
Please use the Information Hub
37
for up to date details on how to request more
BASRiS forms for your organisation. To note, BASRiS forms will be numbered to
prevent misuse.
The completed BASRiS form should be sent as quickly as possible to Social Security
Scotland at this address:
BASRiS Form
PO Box 27165
Glasgow
G4 7BR
11. CLAIMING FOR A FEE FOR COMPLETION OF A BASRiS FORM
Eligibility to claim a Fee
Independent GP contractors and private GPs, as well as GPs and RNs employed by
the independent contractor and private GP practices, can submit a claim on behalf of
the GP practice.
RMPs and RNs who are employed by a third sector organisation (for example a
charity) can submit a claim on behalf of that organisation.
35
http://www.legislation.gov.uk/ukpga/2018/12/contents/enacted
36
https://www.legislation.gov.uk/ssi/2013/50/contents/made
37
https://www.socialsecurity.gov.scot/terminal-illness
24
Details of when a fee can be claimed by other medical staff are contained in the
Terms and Conditions for Medical Staff in Scotland.
Process for claiming a Fee
Please use the Information Hub
38
for up to date details on how to request more fee
payment forms.
You should include the relevant payment details on the BASRiS fee payment form
(example in Annex I), in order for Social Security Scotland to process your payment.
Completed fee payment forms should be posted to this address:
BASRiS Fee Payment Form
PO Box 27165
Glasgow
G4 7BR
This will be processed upon receipt of the BASRiS form and BASRiS fee payment
form within 30 days.
The fee for completion of the form will be: £17
38
https://www.socialsecurity.gov.scot/guidance-resources/guidance/requesting-a-basris-form
25
ANNEX B
MATRIX TO SUPPORT THE CLINICAL JUDGEMENT PROCESS
Decision of whether the individual has (having had regard to the CMO guidance), a
progressive disease that can reasonably be expected to cause the individual’s death,
can be helped by any one or a combination of the additional criteria and indicators
below. This could also take account of the carer’s own experience of his/her
worsening circumstances or distress, which is affecting the care of the individual.
Some additional criteria and indicators which may suggest that a patient is
terminally ill
Making a clinical judgement of terminal illness is an extremely complex professional
clinical process, which can be an intuitive one, pulling together a range of clinical, co-
morbid, social and other factors that give a whole picture of deterioration.
Criteria
Below are some of the criteria, which may be considered. It is not necessary for all
the indicators to be present but several in combination would be expected. For
example:
The disease is advanced
The disease is progressive with decreasing reversibility
There will be deterioration of an incurable condition
Increasing need for input of health and social care providers
The terminal condition is not amenable to further curative treatment, or
alternative treatment which is not tolerated or chosen by the patient or their
legal representative
Where death will be an inevitable consequence of the condition
Any significant events that are likely to impact on function and life e.g. fall with
significant harm
Rapid/erratic decline, unstable
A deteriorating condition carrying a high risk of sudden death
Worsening or anticipated worsening of symptoms despite optimal
management
General indicators of decline and specific clinical indicators of terminal illness
A) Are there general indicators of decline – deterioration and increasing
assistance for care and mobility required (it is not necessary for all the
indicators to be present)?
Decreasing activity and function – (functional performance status declining e.g.
Barthel score) limited self-care, in bed or chair for more than 50% of day, and
increasing dependence in most activities of daily living
Increasing dependence on others for unstable or deteriorating physical and
mental health
26
The individual’s carer needs more help and support
Significant appetite and weight loss over the last few months, or remains
underweight (although some patients may gain weight – such as those with
heart failure), or loss of muscle mass
Persistent or worsening symptoms or complex symptoms despite optimal
treatment of underlying condition/s
Repeated unplanned/crisis admissions
Sentinel Event e.g. fall with significant harm
No available treatment option that would lead to recovery or the person chooses
not to have curative treatment for the disease causing the terminal illness
Functional Indicators
Barthel Index describes basic Activities of Daily Living (ADL) as ‘core’ to the
functional assessment e.g. feeding, bathing, grooming, dressing, continence,
toileting, transfers, mobility, coping with stairs, etc.
https://www.physio-pedia.com/Barthel_Index
39
https://www.mdcalc.com/barthel-index-activities-daily-living-adl#use-cases
40
PULSE ‘screening’ assessment - P (physical condition); U (upper limb function);
L (lower limb function); S (sensory); E (environment).
Australia Modified Karnofksy Performance Status Score 0-100 ADL scale.
https://ahsri.uow.edu.au/content/groups/public/@web/@chsd/@pcoc/docume
nts/doc/uow129188.pdf
41
WHO/ECOG Performance Status 0-5 scale of activity.
https://ecog-acrin.org/resources/ecog-performance-status
42
B) Are there specific clinical indicators of terminal illness related to
certain conditions?
Cancer (where decline may be rapid or more predictable)
Functional ability deteriorating due to progressive cancer
Too frail for cancer treatment or treatment is only for symptom control
Where any anti-cancer treatment is not aimed at eradicating disease
Organ Failure (where decline is erratic)
Respiratory Disease
Severe chronic lung disease, with breathlessness at rest or on minimal effort,
between exacerbations (e.g. FEV1 <30% predicted in COPD, more than 6
weeks of systemic steroids for COPD in preceding 6 months)
Persistent hypoxia requiring long term oxygen therapy
Has needed ventilation for respiratory failure or ventilation is contraindicated
39
https://www.physio-pedia.com/Barthel_Index
40
https://www.mdcalc.com/barthel-index-activities-daily-living-adl#use-cases
41
https://ahsri.uow.edu.au/content/groups/public/@web/@chsd/@pcoc/documents/doc/uow129188.pd
f
42
https://ecog-acrin.org/resources/ecog-performance-status
27
Recurrent hospital admissions (more than 3 in last 12 months due to COPD)
Signs and symptoms of right heart failure
Combination of other factors – i.e. anorexia, previous Intensive Care Unit/Non
Invasive Ventilation (ITU/NIV) resistant organisms
Heart/Vascular Disease
Heart failure or extensive untreatable coronary artery disease; with
breathlessness or chest pain at rest or on minimal exertion
Severe inoperable peripheral artery disease
Repeated hospital admissions with heart failure symptoms
Kidney Disease
Stage 4 or 5 Chronic Kidney Disease (CKD) – eGFR<30ml/min, with
deteriorating health
Kidney failure complicating other life limiting conditions e.g. symptoms of
nausea and vomiting, anorexia, pruritus, reduced functional status and
intractable fluid overload
Stopping or not starting dialysis, even following transplant failure
Liver Disease
Cirrhosis with one or more complications in the past year – diuretic resistant
ascites; hepatic encephalopathy; hepatorenal syndrome bacterial peritonitis;
recurrent variceal bleeds
Liver transplant is not possible.
General Neurological Diseases
• Progressive deterioration in physical and/or cognitive function despite optimal
therapy
• Speech problems with increasing difficulties in communicating
• Swallowing problems (dysphagia) leading to recurrent aspiration pneumonia,
sepsis
• Breathlessness or respiratory failure
• Labile blood pressure
• Speech problems with increasing difficulty in communications (progressive
dysphasia).
Specific Neurological Diseases
Parkinson’s Disease
Reduced independence, needs increasing help with activities of daily living
Dyskinesias, mobility problems and falls
Psychiatric signs (depression, anxiety, hallucinations, psychosis)
Increased cognitive difficulties/significant cognitive deterioration
Similar pattern to frailty with one or more co-morbid diseases/conditions - see
“Frailty with one or more co-morbid diseases/conditions” section below.
Motor Neurone Disease
Marked rapid decline in physical status
Difficulty in swallowing, first episode of aspiration pneumonia
Low vital capacity (below 70% of predicted using standard spirometry)
Weight Loss
28
Increased cognitive difficulties
Significant complex symptoms and medical complications
Communication difficulties.
Multiple Sclerosis
Significant complex symptoms and medical complications
Dysphagia, poor nutritional status
Communication difficulties e.g. Dysarthria, fatigue
Cognitive impairment e.g. dementia – see “Dementia” section below.
Stroke
Dense paralysis
Minimal conscious state
Progressive deterioration in physical and/or cognitive function despite optimal
therapy
Swallowing problems (dysphagia) leading to recurrent aspiration pneumonia,
sepsis,
Breathlessness or respiratory failure
Speech problems with increasing difficulty with communication (progressive
dysphasia)
Frailty with stroke and post stroke dementia – see “Dementia” section below.
Frailty with one or more co-morbid diseases/conditions and Advanced
Dementia (where there is gradual decline)
Dementia - There are many underlying conditions, which may lead to degrees of
dementia, and these should be taken into account. Triggers to consider that indicate
that someone is entering a later stage are:
Unable to walk, dress or eat without assistance,
Eating and drinking less, difficulty in swallowing
Weight loss
Urinary and faecal incontinence
Not able to communicate by speaking i.e. no meaningful conversation, little
social interaction
Frequent falls, with or without fractures
Recurrent febrile episodes or infections, aspiration pneumonia
Severe pressure sores e.g. ulcers with deeper involvement of underlying tissue
with more extensive destruction, such as extending into the muscle, tendon or
even bone.
29
TOOLS TO SUPPORT CLINICAL JUDGEMENT
University of Edinburgh Supportive and Palliative Care Indicators Tool
(SPICT™)
SPICT April2017.pdf
https://www.spict.org.uk/
43
ihub Palliative Care Identification Tools Comparator
palliative-care-ident
ification-tools-comparator.pdf
https://ihub.scot/media/2079/palliative-care-identification-tools-comparator.pdf
44
Outcome Assessment and Complexity Collaborative – Summary of Suite of
Measures
Healthcare Improvement Scotland’s Scottish Anticipatory Care Programme
https://ihub.scot/project-toolkits/anticipatory-care-planning-toolkit/anticipatory-care-
planning-toolkit/
Effective Communication for Healthcare – Anticipatory Care Planning in
Scotland
http://www.ec4h.org.uk/resources/anticipatory-care-planning-in-scotland/
43
https://www.spict.org.uk/
44
https://ihub.scot/media/2079/palliative-care-identification-tools-comparator.pdf
30
ANNEX C
WORKED EXAMPLES (ADULTS, BABIES, CHILDREN AND YOUNG PEOPLE)
Adult Examples
Colon cancer (break-down in relationship with GP) – Simon
Simon is 45. He was diagnosed with colon cancer and liver metastasis, and is
undergoing palliative chemotherapy. He was not issued a BASRiS form at his initial
referral.
Simon had been seeing his GP for up to two years with symptoms consistent with his
diagnosis. Simon’s view is that the GP failed to send him for tests until recently, leading
to a delay in the diagnosis. Simon does not want to approach his GP due to a
breakdown in their relationship.
Simon has a number of options in this situation. He is still able to make an application
to Social Security Scotland for disability assistance when Adult Disability Payment has
commenced in Scotland, indicating that he has a terminal illness and explaining his
declining condition. Social Security Scotland could seek to obtain a BASRiS form on
his behalf by contacting the healthcare practitioner Simon names on the application
form and enquiring whether a BASRiS is appropriate.
Simon could approach another GP in the practice, who has access to his clinical
records, as well as reports from other professionals involved in his care. He could
also approach the specialist doctor involved in his care. Either doctor would be able
to sign the BASRiS form.
Simon would also be able to make a complaint through the NHS complaints procedure
if he wished to do so. This would not be a matter for Social Security Scotland.
COPD - Marilyn
Marilyn is 58. she has severe COPD and graded as Medical Research Council (MRC)
grade 4 (Stops for breath after walking about 100 metres or after a few minutes on
level ground.)
She can walk up to 500 metres with frequent pauses for breath, using a wheeled
trolley, continues to smoke, experiences infective exacerbations perhaps 4 times per
year, and has required one admission for this in the last year.
She would be graded as Group D in the Global Initiative for Chronic Obstructive Lung
Disease (GOLD) criteria (Group D: high risk (≥2 exacerbations per year, or one or
more requiring hospitalisation) and more symptoms Modified Medical Research
Council dyspnoea scale (mMRC)≥ 2 or COPD Assessment Test (CAT)≥ 10).
Marilyn will almost certainly die within the next few years, but currently there are no
signs of rapid decline and completion of a BASRiS form at this stage would be
inappropriate.
31
COPD (choosing not to take clinical advice) – Archie
Archie is 52 and has COPD. He has refused to comply with medical advice about his
lifestyle and does not take his prescribed medication. If this continues, Archie’s GP
expects that he will die within a year.
It is Archie’s human right to choose his course of treatment (including refusing
treatment), and if his GP’s diagnosis is that Archie’s condition presents an imminent
threat to his life without management, then the GP should complete a BASRiS form
for Adult Disability Payment once it has commenced in Scotland.
Dementia, frailty with one or more co-morbid diseases/conditions, and recurrent
pneumonia – Moira
Moira is an 87 year old who lives with her husband. Over the last few years, she has
been developing symptoms of dementia and has become increasingly frail. Owing to
a desire to maintain independence, and a fear that contact with health and social care
would result in Moira “being put into a home”, they have not sought help until recently,
when Moira developed recurrent pneumonia. It is felt that this was as a result of
swallowing problems caused by her dementia.
On its own, Moira’s dementia would be unlikely to lead a clinician to diagnose her as
terminally ill for the purposes of access to disability assistance. However, the
multimorbid combination of dementia with recurrent pneumonia may lead a clinician
to judge Moira’s condition as terminal, and to complete a BASRiS form in relation to a
claim for Pension Age Disability Payment (which only has a care component), once
that benefit is being delivered by Social Security Scotland.
Duchenne Muscular Dystrophy - John
John is a 24 year old man with Duchenne Muscular Dystrophy. In general, he has
done better than his elder brother who died 5 years ago from complications of the
same condition. This discrepancy between John and his brother is likely to be due to
a number of medical interventions, which John has undergone, including: the
orthopaedic insertion of rods in his back, the introduction of feeding by gastrostomy,
robust management of his underlying cardiac condition, and the use of overnight non-
invasive ventilation. In recent months, John has required the use of his non-invasive
ventilator for longer periods throughout the day and night. So far, he and his parents
have not wanted to discuss detailed planning for the future, and have preferred not to
engage with statutory services about Adult Disability Payment.
John develops a significant chest infection, and after a 2 week period in hospital is
discharged home, where it is clear that both parents will now both need to stay at
home to help look after him. After much discussion with their Respiratory Physician
and their District Nurse, they approach their GP to assist them with a claim for Adult
Disability Payment.
In this case, the GP must use their clinical judgement consulting the Clinical
Assessment of Terminal Illness section – as well as evidence gathered from John’s
specialist, nurse, and family – to establish whether John’s condition is likely to lead to
his death. If John’s condition is judged to be terminal, then the GP should complete a
32
BASRiS form in relation to Adult Disability Payment. This would fast-track John to the
highest rates of both care and mobility for the benefit. However, if John’s condition
has worsened, but has since stabilised and he does not require expedited access to
benefits, the family should apply for Adult Disability Payment through the standard
route.
In either case, the GP should also sign-post John’s parents to Carer’s Allowance (a
devolved benefit currently, being delivered by DWP), and the Carer’s Allowance
Supplement (a Scottish benefit administered by Social Security Scotland), since one
of them may be eligible.
Elderly with several conditions - Chen
Chen is 84. She has a longstanding diagnosis of Alzheimers disease and has
previously been thought to be mildly affected, managing to live alone with a minimal
package of care. She was unfortunately hospitalised 3 months ago with an
intracerebral haemorrhage, which has left her with significant left-sided weakness.
Shortly after hospital discharge, she developed worsening confusion and agitation.
She was again admitted to hospital and treated for urinary tract infection. Since
subsequent discharge 2 months ago, she remains significantly confused, her mobility
has deteriorated substantially, and she is requiring maximal package of care at home.
Chen’s condition is such that she would be eligible for the Pension Age Disability
Payment under the special rules, and a BASRiS form can be completed by her GP or
hospital doctor.
Glioblastoma (appointee) - Abdul
Abdul is a 56 year old man who was diagnosed with Glioblastoma in September 2016.
Because of diminished mental capacity as a result of his condition, Abdul had an
appointee until recently. However, following a breakdown in their relationship, he has
appointed MacMillan’s Welfare Rights Service as responsible for his benefits until his
death.
Abdul has an existing DS 1500 in relation to Universal Credit (UC) claim and for his
Personal Independence Payment (PIP) with Department for Work and Pensions
(DWP). Abdul’s GP need not take any action. The DS 1500 will remain in place for his
UC claim. The DS 1500 will be automatically accepted in place of a BASRiS form,
when Adult Disability Payment is implemented in Scotland and Abdul will be
transferred to the Scottish system in time. If approached by the MacMillan Welfare
Rights Service, in their capacity as Abdul’s appointee, this should be explained to
them.
Heart Failure - Harry
Harry is 56, and was diagnosed with Heart Failure recently. He gave up work quite
suddenly as his fatigue and breathlessness were triggered by even minor physical
activity and he found it difficult to keep up with the physical demands of his job.
Harry recently had an admission to hospital because of his heart failure. Even though
his prognosis is unpredictable, Harry has significant supportive care needs. Harry’s
GP was reluctant to sign a DS 1500 because; she could not predict that he was in his
33
last 6 months of life. People with Heart Failure often experience periods of decline and
recovery, which can make this prediction particularly difficult.
Under BASRiS rules, Harry’s GP has the discretion to use her clinical judgement about
his deterioration in being able to cope with activities of daily living, his recent hospital
admission and the persistence of worrying symptoms despite optimal treatment. If
Harry is deemed to be terminally ill, his GP should fill in a BASRiS form for Adult
Disability Payment when this has commenced in Scotland. This would entitle Harry to
the highest rates for both mobility and care.
Harry may also be eligible for Employment Support Allowance, however, if he wished
to access this benefit under special rules for terminal illness, he would need to meet
the DWPs terminal illness definition, since the benefit is currently reserved to the UK
Government. However, he is still able to apply through the standard route. Since the
benefit is currently reserved to the UK Government he would need to contact DWP to
apply for this benefit.
Cancer of the intestine (migration from DS 1500) - Gary
Gary is 67. He is currently not in receipt of any disability benefits. He has a diagnosis
of cancer of the intestine. Following unsuccessful surgery, the cancer spread
throughout his abdomen and lungs. Gary is the main carer for his wife (66), who has
a rare heart condition that leaves her very breathless, dizzy and fatigued. His wife
currently receives the Attendance Allowance (which only has a care component).
Gary’s consultant established that he was “terminally ill” as per the DWP definition,
and completed form DS1500 on his behalf. Following this Gary was fast-tracked onto
Attendance Allowance (which only has a care component), at the higher rate.
When BASRiS was introduced, Gary presented at his GP requesting that he be
transferred to the Scottish system, to take advantage of the additional rules under
BASRiS. Since he already has a DS1500, Gary will be transferred to the Scottish
system in time, and the GP will not need to do anything further. If he is not already
claiming Carer’s Allowance (a devolved benefit currently being delivered by DWP) and
the Carer’s Allowance Supplement (a Scottish benefit being administered by Social
Security Scotland), the GP may also flag his potential eligibility for this benefit in
relation to the care he provides to his wife.
Terminal lung cancer (but patient currently feels well) - Frank
Frank is 55. He was diagnosed with lung cancer 9 months ago. Frank’s very direct-
talking oncologist has told him that his illness is advanced and progressive. However,
at the moment, Frank feels surprisingly well. Aside from a bit of a cough (which is not
really any worse than the one he usually has), he is free of symptoms. He can do
pretty much everything he wants to do – get out and about, look after himself and still
take care of his grandchildren.
Frank’s oncologist has been clear that his condition is deteriorating, and is likely to
result in his death in the near future. Furthermore, his condition may deteriorate
suddenly, and without warning. Frank would be eligible for Adult Disability Payment
(when implemented in Scotland), under BASRiS based on Frank’s oncologist’s
assessment.
34
Although Frank currently feels well, it is very likely that his care needs will increase
quickly. It is advisable that Frank applies for Adult Disability Payment under BASRiS
at his earliest convenience.
Motor Neurone Disease (rapid decline in condition) - Derek
Derek is 54 years old and, 3 months ago, was diagnosed with Motor Neurone Disease
(MND), a rapidly progressing terminal illness. Already Derek has lost much of the use
of his hands and is walking with a limp. It is anticipated that he will soon need to use
a wheelchair. He could request a BASRiS form or the RMP may decide to consider
completing a BASRiS form for him.
Consulting the Clinical Assessment of Terminal Illness section of the Guidance
(currently Section 7), and speaking to Derek’s MND clinical specialist, his GP sees
that, with a diagnosis of MND, Derek meets or surpasses the indicators listed.
His GP decides that, clearly, Derek qualifies for a BASRiS and needs to be fast-tracked
for his benefits. Derek’s GP promptly completes the BASRiS form and sends it to
Social Security Scotland. This enables Derek to receive Adult Disability Payment, at
the highest rates, and may allow his partner to access Carer’s Allowance (a devolved
benefit currently being delivered by DWP) and the Carer’s Allowance Supplement (a
Scottish benefit being administered by Social Security Scotland), much quicker than if
he had to apply following the normal route.
Multi-morbidity and frailty - Brenda
Brenda is 103 and lives at home, supported by her daughter and great neighbours.
She has diagnoses of dementia (early stage), arthritis, macular degeneration, diabetes
and is generally very frail, and getting less mobile and able to look after herself. She
has periodic chest infections, which can get quite bad – sometimes these are managed
at home, but a couple of times in the last 5 years she has been admitted to hospital.
BASRiS may be appropriate in this case, if the clinical judgement after consulting the
Clinical Assessment of Terminal Illness section is that Brenda has severe frailty. Were
Brenda to apply for the Pension Age Disability Payment when it is implemented in
Scotland, (which only has a care component), and qualify under BASRiS, her claim
would be fast-tracked. Her award would be at the higher rate, with no review period.
Brenda’s daughter or one of her neighbours may be eligible for Carer’s Allowance (a
devolved benefit currently being delivered by DWP) and the Carer’s Allowance
Supplement (a Scottish benefit being administered by Social Security Scotland), if
Brenda is awarded the Pension Age Disability Payment.
Unknown neurological disorder - Kate
Kate is 47. She is an ex healthcare worker who lives alone, with supportive son and
daughter nearby. There is a background of COPD with longstanding heavy smoking.
She has been under neurology review for a year with steadily progressive imbalance
and speech problems, which have been deteriorating over the year. She is now using
a wheelchair and able to walk only a few steps. Despite detailed investigation, no
specific cause has been found. Attempted treatments have not helped. Her consultant
believes she may have a cancer-related (paraneoplastic) disorder related to an
35
unidentified tumour, or perhaps a degenerative disorder. She cannot suggest any
further treatments. Her son and daughter are increasingly struggling to support her
because of poor mobility and shortness of breath. She was recently hospitalised with
pneumonia.
If it is Kate’s consultant’s clinical judgement that Kate is likely to die from her condition,
then she should fill out a BASRiS form, to allow Kate to access Adult Disability
Payment under special rules. Kate’s son or daughter may be eligible for Carer’s
Allowance (a devolved benefit currently being delivered by DWP) and Carer’s
Allowance Supplement (a Scottish benefit being administered by Social Security
Scotland). It is not necessary for the consultant to be certain, nor is it necessary for
the condition to have a confirmed named diagnosis if Kate displays indicators set out
in the CMO guidance.
Old age - Ina
Ina is a 92 year old lady who lives alone in a retirement flat. She has been active and
independent since an aortic valve replacement ten years ago. She receives blood
thinning for her metallic heart valve and treatment for high blood pressure, previous
angina, and an underactive thyroid. She was managing 9 holes of golf a week until the
end of last summer, but has given this up for fear of slowing her friends down. Since
then, visitors have commented to her that she seems to be losing weight. After a
discussion with her GP, she has decided against any investigations regarding this, but
her weight loss continues and she has recently started to rely on her neighbours more
and more.
Ina’s clinician would need to establish whether she was likely to die from one, or a
combination, of these diagnosed or undiagnosed conditions. If it is the clinical
judgement of the GP, after consulting the Clinical Assessment of Terminal Illness
section, that Ina’s condition/s are terminal, and she is likely to die soon, they should
complete a BASRiS form in relation to a claim for the Pension Age Disability Payment,
(which only has a care component), when it is implemented in Scotland. However, if it
is the clinician’s judgement that Ina’s condition is consistent with, and typical of old
age alone, this would not be grounds alone for completion of the BASRiS, and Ina
should be encouraged to make an application for the Pension Age Disability Payment
(which only has a care component), by the standard route.
Reduced mental and physical capability following a stroke (existing DS 1500) –
Jennifer
Jennifer is 52. Jennifer has reduced mental and physical capability following a stroke,
and currently receives the highest rates of Adult Disability Payment, for both care and
mobility. Jennifer presents at her GP with symptoms including headaches and
vomiting. After a specialist appointment, Jennifer’s GP informs her that she has
advanced Glioblastoma. Exercising clinical judgement, Jennifer’s GP deems her
condition terminal under the Clinical Assessment of Terminal Illness section.
Although Jennifer is already on the highest rate of the Adult Disability Payment the
additional rules under BASRiS e.g. the lack of reassessment period, make it
36
worthwhile transferring to the terminal illness rules. This should be done through the
BASRiS form, as with any other person who is terminally ill.
Children and Young People’s examples
Rare brain tumour - Fiona
Fiona is a 6 year old girl with a rare brain tumour, which is very unresponsive to
chemotherapy, radiotherapy or surgery. She is being considered for phase one and 2
trials, but none fits with her condition. She is being maintained on low doses of
dexamethasone with boost of doses, and with oral etoposide, which is a form of
palliative chemotherapy. Fiona has spent a number of months as an inpatient in the
local children’s ward.
She has twin sisters who are 2 years old, and her Mum has not returned to work since
their birth, which was just after Fiona’s initial diagnosis. Both of Fiona’s parents are
still hopeful that she can improve and are in touch with multiple specialist groups
across the world, but at present her father is about to be made redundant because of
a re-organisation at his work.
Using clinical judgement consulting the Clinical Assessment of Terminal Illness section
– and having gathered evidence from specialist nurses who have worked with Fiona
on the children’s ward – the medical practitioner should establish whether Fiona is
likely to die from her condition. Following this diagnostic process, the medical
practitioner has a number of options.
1. If Fiona’s condition is judged to be terminal:
a) Fiona’s parents are hopeful, but this may not reflect the seriousness of Fiona’s
condition, then the medical practitioner may fill out a BASRiS form (in relation to a
claim for Child Disability Payment without informing the parents of the terminal nature
of Fiona’s condition (if this information is deemed to be harmful); or
b) The medical practitioner may wish to have the difficult conversation with the parents,
to inform them of the nature of Fiona’s condition, and complete a BASRiS form with
their full knowledge and consent.
Both options – 1a and 1b – would fast-track Fiona’s claim, and automatically entitle
her to the highest rates for both care and mobility.
2. If it is established that Fiona is likely to recover, the medical practitioner should still
signpost the family toward Child Disability Payment, when it is implemented in
Scotland. They would simply apply through the standard route, without recourse to the
special rules.
In all cases above, the medical practitioner should also signpost Fiona’s parents to
Carer’s Allowance (a devolved benefit currently being delivered by DWP) and the
Carer’s Allowance Supplement (a Scottish benefit administered by Social Security
Scotland), since one of them may be eligible.
37
Inherited condition which is terminal – Rizwan
Rizwan is a 3 month old baby who was born by Caesarean Section at 32 weeks
gestation, following the antenatal diagnosis of an inherited condition. It was not clear
if he would survive beyond the first few days, and at this point is being considered for
transfer to a high dependency unit. Rizwan may require a tracheostomy to maintain
his airway in the long term, but he remains at considerable risk of a deterioration, which
could lead to death in the next few years. Six years ago, Rizwan’s parents had a little
girl who sadly died from a variant of the same condition.
Rizwan’s parents are unable to work, and they have two other children aged 4 and 7.
Rizwan’s clinician may use their clinical judgement to establish whether Rizwan is
likely to die of this condition. If Rizwan’s clinician, consulting the Clinical Assessment
of Terminal Illness section, judges that he is terminally ill, she should fill out the
BASRiS form in relation to a claim for the Child Disability Payment, when it is
implemented in Scotland. This would fast-track Rizwan’s claim, and automatically
entitle him to the highest rate of care. The clinician should also signpost Rizwan’s
parents to Carer’s Allowance (a devolved benefit currently being delivered by DWP)
and the Carer’s Allowance Supplement (a Scottish benefit administered by Social
Security Scotland), since one of them may be eligible.
38
ANNEX D
39
40
41
42
ANNEX E
CURRENT BENEFITS DEVOLVED TO SCOTLAND - Social Security in Scotland by Recipient Group
Key Benefits covered by this guidance are marked with *
Devolved benefits are in bold type
Benefits for
people out of
work
Benefits for
elderly people
Benefits for people who
are ill or disabled
Benefits for
families with
children
Benefits for people on
low incomes
Other
Income
Support
In Work
Credit &
Return to
Work Credit
Job Grant
Jobseekers
Allowance
Winter Fuel
Payments
Financial
Assistance
Scheme
Pension Credit
State Pension
State Pension
Transfers
TV Licences
Attendance Allowance *
Carer’s Allowance
Carer’s Allowance
Supplement
Disability Living Allowance
*
Personal
Independence Payment *
Severe Disablement
Allowance
Employment & Support
Allowance
Incapacity Benefit
Industrial Injuries
Specialised Vehicles fund
Statutory Sick Pay
Child Benefit
Child Tax Credit
Guardians
Allowance
Maternity
Allowance
Statutory
Maternity Pay
Discretionary Housing
Payments
Scottish Welfare Fund
Regulated Social Fund
(Sure Start Maternity
Grant, Cold Weather
Payments and Funeral
payments)
New Deal & Employment
Programme Allowances
New Enterprise Allowance
Working Tax Credit
Housing Benefit
Universal
Credit, inc. UC
Scottish
Choices
Bereavement
benefits
Christmas
bonus
Other small
benefits such as
child trust fund
etc.
43
Devolved Benefits that are Affected or Not Affected by BASRiS
Benefit
Primary benefit purpose
Disability Benefits Requiring
BASRiS
when their Scottish
replacements are in place in
Scotland
Attendance
allowance
45
To help with personal care for individuals aged
65 or over with a physical or mental disability.
Disability
Living
Allowance
46
Help if your disability or health condition means
one or both of the following are true: You need
help looking after yourself, or you have walking
difficulties.
DLA is closed to new working age claimants and
being replaced by Personal Independence
Payment (PIP).
Personal
Independence
Payment
47
Helps with some of the extra costs caused by
long term ill health or disability for individuals
aged 16 to 64. Replacement for DLA for working
age individuals.
Devolved
Benefits
a patient
or carer may be entitled to.
Carer’s
Allowance
48
To help an individual look after someone with
substantial caring needs. To be eligible the
individual must be 16 or over and spend at least
35 hours a week caring for them.
Carer’s
Allowance
Supplement
49
An extra payment to help carers in Scotland who
get Carer’s Allowance
UC Scottish
Choices
50
UC Scottish choices
51
give recipients of
Universal Credit (UC) in Scotland a choice to
have their UC award paid either monthly or twice
monthly, and have the housing costs in their
award of UC paid direct to their landlord.
Details of all devolved benefits can be found here
45
https://www.gov.uk/attendance-allowance
46
https://www.gov.uk/browse/disabilities/benefits
47
https://www.gov.uk/pip
48
https://www.gov.uk/carers-allowance
49
https://www.gov.scot/policies/social-security/benefits-for-carers/
50
Social security: Universal Credit (Scottish choices) - gov.scot (www.gov.scot)
51
Social security: Universal Credit (Scottish choices) - gov.scot (www.gov.scot)
44
ANNEX F
DS 1500
45
ANNEX G
THE SCOTTISH SOCIAL SECURITY PRINCIPLES
The Scottish social security principles are:
social security is an investment in the people of Scotland
social security is itself a human right and essential to the realisation of other
human rights
the delivery of social security is a public service
respect for the dignity of individuals is to be at the heart of the Scottish social
security system
the Scottish social security system is intended to contribute to reducing poverty
in Scotland
the Scottish social security system is should be designed with the people of
Scotland on the basis of evidence
opportunities should be sought to continuously improve the Scottish social
security system in ways which -
o put the needs of those who require assistance first, and
o advance equality and non-discrimination
the Scottish social security system should be efficient and deliver value for
money.
Effect of the principles
The Scottish social security principles are to be reflected in the Scottish social
security charter
The Scottish Commission on Social Security is to have regard to the principles in
preparing reports on proposals for legislation
A court or tribunal in civil or criminal proceedings may take the Scottish social
security principles into account when determining any question arising in the
proceedings to which the principles are relevant.
Breach of the principles does not itself give rise to grounds for any legal action.
Link to the Social Security (Scotland) Act 2018:
http://www.legislation.gov.uk/asp/2018/9/pdfs/asp_20180009_en.pdf
52
Link to Schedule 5 – Disability Assistance Regulations (introduced by Section
31 of the Act):
http://www.legislation.gov.uk/asp/2018/9/schedule/5/enacted
53
52
http://www.legislation.gov.uk/asp/2018/9/pdfs/asp_20180009_en.pdf
53
Social Security (Scotland) Act 2018 (legislation.gov.uk)
46
Implications for Disability Benefits under Special Rules – Terminal illness
If eligible for special rules, the patient’s application for benefits assistance will be
processed differently to standard benefit applications. This means that:
There is no qualifying period. An individual is not required to have the condition
for any length of time before they are eligible under special rules.
Once verification has been given that the person is considered to have a
terminal illness, for the purpose of entitlement to disability assistance, there is
no requirement for an individual to undergo any further assessment to establish
that a person has a terminal illness.
Awards will be calculated, at the latest, from the date of application by the
patient.
Patients who qualify under special rules will be automatically entitled to the
highest rate of the component part(s) of whichever benefit they are entitled to
e.g. the current Attendance Allowance does not have a “mobility” component.
It may also enable the patient’s carer(s) to access Carer’s Allowance quicker, as this
is a ‘passported’ benefit, dependent on the patient receiving one of the disability
benefits.
The information in this guidance will also be relevant to other practitioners who advise
patients regarding benefits assistance e.g. Citizens Advice Scotland.
47
ANNEX H
FURTHER SUPPORTING INFORMATION
Information Leaflets
Two information leaflets have been developed. These are intended to highlight the
recent changes and new processes in Scotland for accessing disability assistance
for people who are terminally ill.
Please use this link to access the leaflet for clinicians
54
.
Please use this link to access the leaflet for people who are terminally ill and those
who support them
55
.
Frequently Asked Questions
To further support clinicians in using this guidance and supporting patients who are
terminally ill a list of frequently asked questions has been developed. Please use this
link to access the FAQs
56
.
Information Hub
All related information to support clinicians using the new terminal illness definition is
being published in one place on Social Security Scotland’s website. This includes:
CMO guidance
FAQs
CMO / CNO letter to all RMPs and RNs
Information leaflets (for clinicians and for people who are terminally ill and those
who support them)
Clear information regarding launch dates of each new disability benefit and
clear guidance regarding when the new terminal illness definition is live for each
age group
Clear guidance on whether a DS1500 form or a BASRiS form is required
Information on where BASRiS forms can be obtained and where they need to
be sent
Information on Social Security Scotland’s ‘Clinical Helpline’ which has been
established to support clinicians
54
https://www.socialsecurity.gov.scot/guidance-resources/guidance/special-rules-for-terminal-illness-
factsheet-for-clinicians
55
https://www.socialsecurity.gov.scot/guidance-resources/guidance/special-rules-for-terminal-illness-
leaflet-for-patients
56
https://www.socialsecurity.gov.scot/guidance-resources/guidance/special-rules-for-terminal-illness-
frequently-asked-questions
49
ANNEX I
BASRiS FEE PAYMENT FORM
For General Practitioners and RMPs and RNs in GP Practices and in third
sector organisations not employed by Health Boards
This is an example of the Fee Payment Form which can be used to claim a fee for a
submitted BASRiS form. Please complete all the boxes on this form to assist
payment. Payment can only be made if the completed Fee Payment Form (and the
related BASRiS form) is received by Social Security Scotland.
50
