Introduction to the First Edition
1.1 Aims of the Handbook
1.1.1 Disability Living Allowance (DLA) and Attendance Allowance (AA) are benefits payable to people who have significant problems with personal care and/or with mobility because of long-term severe physical or mental disability and to those who are terminally ill. Many different medical conditions and developmental abnormalities give rise to such problems.
This handbook is intended to provide for all who are involved with these benefits an authoritative source of information on the likely effects that the more commonly occurring conditions have on a person's care and/or mobility needs. The handbook provides general information about these conditions only. As such it is not intended to be used in preference to evidence available in individual cases, as conditions do affect different people in different ways.
The purpose of this handbook is merely to provide a point of reference for those working on DLA and AA, against which to compare such evidence. If there is a considerable difference between the information in the Handbook and the evidence which has been supplied then the Adjudication Officer (AO) may wish to consider seeking further evidence before reaching a decision.
1.1.2 The handbook has been written by medical staff of the Department of Social Security with advice from the Disability Living Allowance Advisory Board (DLAAB) and contributions from many organisations representing people with disabilities. The Benefits Agency Medical Services together with the DLAAB will continue to monitor the information contained in the handbook and will make amendments and/or alterations as new conditions or treatments emerge.
1.1.3 This is not a medical textbook. Adjudication Officers are not medically qualified. Most people involved with the care of people with disabilities have no medical training or background. For these people, a medical textbook would be of no help to their understanding of the care and mobility needs of the people they are dealing with. This handbook is written with this in mind. It contains the minimum of medical terminology so that it can be readily understood by all concerned. Where medical terms cannot be avoided they are either explained in the text, if this does not disturb its flow, or are included in a glossary of terms.
1.2 Type of information included in the handbook
1.2.1 This handbook provides information on many illnesses, diseases and disorders that may give rise to long-term disabilities and to the need for palliative care. It describes, in general terms, the effects of these conditions and the care and mobility needs that can arise from them. For each of these conditions the handbook gives:
(i) a general description of the medical condition, its clinical characteristics and the disabilities which may arise from it;
(ii) an explanation of the likely effects in terms of care and mobility needs;
(iii) an indication of the likely duration of such need,
and,
(iv) sources of further information which may be sought in individual cases which require clarification or amplification.
1.2.2 This handbook contains no advice or guidance on the level of award that should be made. That is a decision for the Adjudicating Authorities alone on the basis of the evidence available in an individual case. The handbook refers only to the likely effects of the conditions described and the care and mobility needs that may generally be expected reasonably to arise from them.
1.3 Target audience for the handbook
1.3.1 The handbook is intended primarily to help Adjudicating Authorities to assess the medical evidence that is presented to them when a claim is made. It is aimed particularly at the Adjudication Officers who decide claims and reviews but it will be available for use by anyone else who wishes to refer to it. As independent statutory authorities Adjudication Officers are at liberty to use whatever source of information they feel appropriate when deciding a claim.
1.3.2 The handbook is also intended to be used by the medical staff of the Benefits Agency Medical Services (BAMS) who may be called upon to give advice to the Adjudicating Officers and to the presenting officers at Tribunal hearings. Not all claims are likely to present a clear picture of the person's care and mobility needs. Not all conditions which may give rise to claims are covered by the handbook; selection has been based on those illnesses and disabilities which occur most commonly or are likely to pose special difficulties in defining the spectrum of care and mobility needs to which they give rise. The handbook and the general principles which underpin it will also assist the Benefits Agency Medical Services Staff in providing consistent and authoritative advice on the effects of disabilities as they relate to the need for care and their effects on walking and other mobility considerations.
1.4 Organisation
1.4.1 The handbook is divided into two principal sections, dealing with disabilities affecting adults [Chapters 3-32] and children [Chapters 33-50], with a final Chapter [45] on Malignant Diseases. For a child the effects of disability arising from a particular condition can be very different from those experienced by an adult. The emphasis of this handbook is on the effects of disability and so it is important to discuss separately the consequences of conditions that affect both children and adults.
1.4.2 Within each section, the chapters describe related conditions that have similar effects. This is to avoid unnecessary duplication of information. The order of the chapters is not significant. There is no distinction in the order between those conditions included because they are common and those conditions included because they may give rise to problems for adjudicators.
1.4.3 Each chapter is divided into sub-sections that give some background information on the conditions included, describe the effects of the disability and indicate the care and mobility needs that may arise. There is also a subsection that discusses the likely duration of need and a sub-section on the most useful sources of additional information.
1.4.4 A glossary of medical conditions, technical phrases, commonly used Latin abbreviations and a comprehensive index are provided.
Mansel Aylward
November 1991