Full list of medical conditions for DWP’s new ‘fast-track’ Universal Credit and PIP – will you get payments quicker?

THOUSANDS of households eligible for Universal Credit and PIP will be able to get payments quicker under new rules.

The Department for Work and Pensions (DWP) has now revealed exactly who will be able to use a new fast-tracked application process.

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The severe disability group (SDG) is being set up to help identify claimants with the most severe and permanently disabling conditions.

If you’re found to be eligible and selected for the group, you’ll be able to go through a fast-track application process for Universal Credit, PIP, and employment and support allowance (ESA).

You’ll get the highest rate of disability benefit available to you without having to go through the usual application and assessment process.

To meet the SDG criteria, the Department for Work and Pensions says claimants must :

• Have an irreversible or progressive condition, confirmed or managed by a secondary care specialist, with no realistic prospect of improvement 
• Have had no significant response to treatment, or treatment will not improve function, or no further treatment is planned
• Have a severe impairment of physical or mental function (or likely to develop this within six months) such that they need assistance from another person to complete two or more activities of daily living

The DWP has also released a full list of the medical conditions eligible for the new group.

Cardiorespiratory conditions

• Three-vessel coronary artery disease
• Heart failure scored three or four on the New York Heart Association (NYHA) and is not a candidate for cardiac transplant
• Pulmonary arterial hypertension
• Severe chronic respiratory condition (e.g. chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease, diffuse pleural thickening) with grade five MRC breathlessness

Neurological conditions

• Severe spinal cord injury with irreversible disability leading to significantly reduced mobility, bladder dysfunction and impairment of upper limb function
• Severe acquired brain injury, advanced dementia or any other condition causing cognitive impairment where the person is in residential care or long-term hospital care or lives at home and assessed as requiring 12 to 24 hour supervision
• Motor neurone disease
• Advanced Parkinson’s disease with bilateral symptoms of tremor, rigidity and bradykinesia and impairment of balance, plus a Unified Parkinson’s Disease Rating Scale (UPDRS) score of 21 to 30
• Advanced multiple sclerosis scoring more than six on the Expanded Disability Status Scale (EDSS)
• Myasthenia gravis, which is refractory to immunosuppressive therapy, with frequent relapses requiring hospital treatment
• Intractable epilepsy
• Stroke

Musculoskeletal or rheumatological conditions

• Late or poorly controlled systemic connective tissue diseases
• Late or poorly controlled inflammatory arthritis

Cancer

• Incurable cancer diagnosis, highly symptomatic where patient’s Eastern Cooperative Oncology Group (ECOG) performance status is greater than or equal to two
• Incurable cancer diagnosis where no suitable active treatment options exist or remain

Gastrointestinal or hepatic conditions

• Treatment resistant inflammatory bowel disease
• End stage liver disease with complications, highly symptomatic, reduced functional status and unsuitable for transplant

Renal conditions

• Stage four or five chronic kidney disease (CKD), highly symptomatic and reduced functional status despite or unsuitable for replacement renal therapy and unsuitable for transplant

Immune or haematological conditions

• Immune deficiency, highly symptomatic despite therapy, reduced functional status
• Aplastic anaemia unsuitable for transplant

Skin conditions

• Severe treatment-resistant inflammatory skin disease
• Genetic skin disease such as xeroderma pigmentosa or epidermolysis bullosa dystrophica

Chronic pain and fatigue

• Syndromes characterised by chronic pain and fatigue where symptoms are longstanding, affect multiple activities of daily living (ADLs)

Sensory conditions

• Presence of combined severe hearing loss (more than 71 decibel loss) and certified as severely sight impaired (deafblind)

Multiple physical conditions

• Multiple impairments, for example, combinations of COPD, coronary artery disease, diabetes and obesity that would not meet the criteria as single conditions but may do so if present in combination

Mental, cognitive and intellectual impairment

• Intellectual disability and meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) five criteria for profound or severe intellectual disability
• Autism spectrum disorders and meet the DSM five level two or level three criteria
• Longstanding schizophrenia, failing to significantly respond to all treatment or rehabilitative options, under the care of specialist psychiatric or support services
• Long term severe depression or bipolar disorder failing to significantly respond to treatment, under the care of specialist psychiatric services
• Long term alcohol or drug dependency, despite repeated unsuccessful withdrawal attempts and treatment by specialist alcohol or substance misuse services
• Borderline or severe personality disorder with longstanding and continued engagement with psychiatric or support services and failure to significantly respond to all treatment options
• Longstanding obsessive-compulsive disorder (OCD), failing to respond to treatment by intensive specialist treatment services, with severe ongoing symptoms resulting in significant difficulties with ADLs

How does the severe disability group work?

The SDG was first introduced in the Health and Disability Green Paper in 2021.

The resulting Health and Disability white paper published in 2023 revealed that the design and testing of the Severe Disability Group had already begun in Autumn of 2022.

Now, the DWP has confirmed that it is extending the testing phase to include a larger number of claimants for PIP.

It’s asking a selected group of clinicians to identify patients they believe are suitable or contacting claimants they think are eligible directly to take part in the testing phase.

Under the SDG process, a doctor or nurse who identifies that a patient meets the criteria must fill out a short form to confirm the patient’s eligibility.

Forms should be completed and returned to [email protected] within 15 working days.

While the focus of the SDG’s testing revolves around PIP for now, the DWP will roll it out to those eligible for Universal Credit and employment and support allowance (ESA) in the future.

In other news, around 326,000 PIP claimants could be due back pay and the DWP is urging those affected to come forward.

It comes after a Supreme Court judgment in July 2019, following an Upper Tribunal decision, changed the way the DWP defines ‘social support’ in one of the assessed PIP categories.

Dubbed the “MM” judgement, the DWP realised that hundreds of thousands could now be due additional support.

It means that people may not have been given one of the two elements of PIP when they were actually entitled to it.

Others may have been awarded the standard rate but should have received the enhanced rate, which is a higher amount.

In response, the DWP began an administrative exercise in 2021, looking at PIP claims since April 6, 2016 to check whether claimants may be eligible for more support.

In its latest update, the DWP says it identified around 326,000 cases to be reviewed.

Around 79,000 cases reflecting MM judgement have been reviewed so far and arrears totalling around £74 million have been paid out to 14,000 people.

The exact amount of backdated PIP payments you could be eligible for will depend on your own circumstances – but the average payout works out at around £5,285 per claim.

Check if you’re affected.

This post first appeared on thesun.co.uk