CRITERIA ONE of the following Functional Support Group (LCWRA) criteria must be met: Mobilising 50m Transfer independently Reaching Picking up and/or moving Manual dexterity Making yourself understood Understanding communication Weekly incontinence Learning tasks Awareness of hazards Personal actions Coping with change Engaging socially Appropriateness of behaviour Unable to eat / drink / chew / swallow / convey food or drink ONE of the criteria is met, ALL FOUR of the following criteria must also be met: Criterion Description Examples of conditions that might meet the criteria Examples of conditions that might not meet the criteria The level of function would always meet LCWRA The level of function would always meet LCWRA criteria Motor Neurone Disease (MND), severe and progressive forms of MS, Parkinson’s, All dementias, All chromosomal conditions, Huntington’s, severe irreversible cardiorespiratory failure, severe acquired brain injury …this list is not exhaustive Conditions which might be severe at times but recovery of function might be present for substantial periods, such as recently diagnosed relapsing forms of MS or some people with less severe mental health conditions with periods of reasonable function Lifelong condition, once diagnosed The condition will always be present. Some lifelong conditions are present from birth, but others will develop or be acquired later in life Conditions which might be cured by transplant / surgery / treatments or conditions which might resolve. This should be based on currently available treatment on the NHS and not on the prospect of scientists discovering a cure in the future
No realistic prospect of recovery of function Advice on this should be on currently available treatment and not on the prospect of scientists discovering a cure in the future As per criterion 1 A person within the 12 months following a significant stroke who may recover function during rehabilitation , so whilst the condition is lifelong, function might improve Unambiguous condition They have been through relevant clinical investigation and a recognised medical diagnosis has been made Non-specific symptoms not formally diagnosed or undergoing investigation all of the above and any of the LCWRA criteria are met, advise the decision maker that the claimant has a Severe Condition and has LCWRA. per filework guidelines request further evidence if it is possible that one or more of the LCWRA criteria might be met but the information has not been provided. request for further evidence should be based on indicators in the clinical information available to you. further evidence is considered necessary to enable advice regarding review or no review for a longer term prognosis further medical evidence review should always be chosen. As per current process only one request for written medical evidence should normally be made and at review only one telephone attempt to chase the evidence is required. If the claimant or their representative needs to be contacted for further evidence then a maximum of two telephone calls should be made. These should be documented on an FRR4. If the evidence is not available, you cannot advise that the claimant has a Severe Condition and normal filework case control action applies. HCPs should not default to calling a claimant to an assessment if the evidence required to meet the criteria is not available. If at filework a HCP feels that enough evidence is available on which a LCWRA ‘in the longer term’ recommendation can be made, but is unable to make a recommendation based on the Severe Conditions criteria, the advice is that they do not seek to call for exam but instead make a paper-based recommendation that change is not expected ‘in the longer-term’. The reason being that DWP believes that to increase the burden on this group of claimants would be unnecessary and go against the spirit of the policy announcement. none of the criteria are met, continue with normal case action. HCP’s default position should be that a future review is required. If you are certain that the evidence indicates that a claimant meets the Severe Conditions criteria, and a future review is therefore not required, this should be fully justified.