This guidance is for clinicians who have a patient with a terminal illness and need to complete a Benefits Assessment under Special Rules in Scotland (BASRiS) form.
The BASRiS form lets Social Security Scotland know that a person is terminally ill.
This guidance is needed because some disability benefits including Personal Independence Payment (PIP), Attendance Allowance and Disability Living Allowance (DLA) have now been devolved to Scotland and will be administered by Social Security Scotland with different rules.
The guidance sets out the rules for accessing those disability benefits where the potential recipient is terminally ill (Benefits Assessment under Special Rules in Scotland (BASRiS)). The guidance introduces:
Other benefits, such as Universal Credit and Employment and Support Allowance, have not been devolved and continue to be administered on a UK basis, by the Department for Work and Pensions (DWP), following existing DWP rules and definitions.
This guidance has been written for registered medical practitioners (RMPs) and registered nurses (RNs) who may provide care for people towards the end of life, and who may be involved in assessing whether an individual is eligible to access BASRiS. The guidance is also relevant to others with an interest/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, including their family and carers.
The Scottish definition of terminal illness applies to Child Disability Payment, Adult Disability Payment, Pension Age Disability Payment and Scottish Adult Disability Living Allowance (Scottish Adult DLA). The definition is also relevant for cases transferring from the Department for Work and Pensions (DWP) to Social Security Scotland. The guidance explains when and how this Scottish definition should be used. The purpose of the guidance is to help RMPs and RNs assess whether someone meets the Scottish definition of 'terminally ill' and therefore is eligible to access disability benefits more quickly and at the highest rates they are entitled to.
The Scottish definition referred to in the Social Security (Scotland) Act 2018, and slightly amended by the Social Security Administration and Tribunal Membership Act 2020, states:
“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 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.”
The 2020 Act amended the 2018 Act to include that ‘appropriate healthcare professional’ must include registered nurse as well as registered medical practitioner.
This guidance supports clinicians to interpret and apply the terminal illness definition consistently, taking account of individual circumstances.
To meet the definition, the individual should have an illness a) that is advanced and progressive or with a 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. View Section 8 and Annex B of the CMO Guidance for more detail.
Notable features of this definition of terminal illness, which are different from some other existing definitions, are:
This guidance contains the information which RMPs and RNs will need to understand and apply the new definition.
Section 1 provides an Executive Summary to the guidance which includes an introduction and background to the changes to disability benefits. This provides the wider context within which the new terminal illness definition is being used.
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 Scottish terminal illness definition.
Also included is a table summarising the differences between the current UK rules and requirements for terminal illness benefits (SR1 form which has replaced the DS1500 form) and the new approach to disability benefits which have been devolved to Scotland (Benefits Assessment under Special Rules in Scotland (BASRiS) form).
Sections 3-6 provide more detail on the legislative underpinning, aim, purpose and principles of BASRiS.
Section 7 is a key section providing more detail on how RMPs and RNs 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.
Section 9 provides information on how to apply this guidance in the case of babies, children and young people.
Section 10 sets out which RMPs and RNs 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.
Annexes (A to I) 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 Scottish definition of terminal illness. Annex C contains some case-based worked examples of how the definition would apply to different individuals.
No. In deciding whether an individual meets the criteria for BASRiS clinical decisions should focus on the individual’s symptoms, clinical indicators and whether the individual meets the terminal illness definition and requires expedited access to benefits, and not the possible causes of these.
Frailty is not classified as a 'disease' at present, but a condition. Legislation (Social Security (Scotland) Act 2018) refers to a very specific definition of terminal illness for the purpose of considering an application under the special rules for terminal illness, i.e. “the individual has a progressive disease that can reasonably be expected to cause the individual’s death.”
Frailty cannot be considered on its own for this purpose. Therefore, frailty with one or more co-morbid progressive diseases, would be required to satisfy the legislative requirements.
This may come under a 'change of circumstances'. It would depend on the whether the individual had a significant improvement of their condition or no improvement in their diagnosis of being 'terminally ill'.
Under the Social Security (Scotland) Act 2018, it is the duty of the individual who requires the benefit, or the person to whom the payments are being made, and those acting on behalf of the individual to notify Social Security Scotland of a change of circumstances.
Failing to notify Social Security Scotland about a change in any of those circumstances in that way may be an offence.
BASRiS stands for Benefits Assessment under Special Rules in Scotland. It replaces the SR1 form (previously DS1500 form) for disability benefits in Scotland. If, as defined in the Chief Medical Officer’s Guidance (for clinicians completing a BASRiS form), an individual has a terminal illness, a RMP or RN can complete a BASRiS form which will provide Social Security Scotland with a confirmation of an individual's terminal illness.
The new Scottish disability benefits:
The SR1 form has replaced the DS1500 form.
The SR1 is the form clinicians can complete if a patient has a terminal illness as defined by the Department for Work and Pensions Guidance (12-month life expectancy).
An SR1 should continue to be completed for an individual where the relevant new Scottish benefit has not yet launched. The RMP or RN completing the SR1 must ensure they complete the form in full, ensuring the declaration section has been filled in and their GMC/NMC number included.
The Department for Work and Pension’s terminal illness definition (12-month life expectancy) will continue to apply for Scottish individuals accessing any reserved benefits (administered by the Department for Work and Pensions) where the individual is terminally ill and eligibility is related to them being diagnosed as such. The Chief Medical Officer’s (Scotland) guidance does not apply to these benefits:
If an individual who is terminally ill applies first for a Social Security Scotland disability benefit, they will require a BASRiS to support their application. Where the individual then goes on to apply for a reserved UK benefit, such as Universal Credit, they will require an SR1 form as this is the supporting information required by DWP. The SR1 form is the replacement for the DS1500.
An individual living in Scotland should send a BASRiS to DWP if they become terminally ill while receiving:
DWP will still accept an SR1 of DS1500 form in this scenario if you do not have a BASRiS.
If an individual already has either an SR1 or a DS1500 for a reserved UK benefit (administered by DWP), they will automatically be eligible under BASRiS rules so do not in addition require a BASRiS to be completed. Social Security Scotland can accept the SR1 or DS1500 where it is submitted instead of a BASRiS.
Social Security Scotland provide a helpline whereby a clinician completing a BASRiS form can seek assistance regarding how they can access the Chief Medical Officer's guidance, what the process of decision making is and how the guidance can best be navigated by that clinician. Where appropriate this will include speaking with one of Social Security Scotland’s clinical practitioners (see helpline link below). Social Security Scotland can’t comment on individual cases as this might prejudice subsequent decision making.
In deciding whether an individual meets the criteria for BASRiS, discussions with all health and social care practitioners and the individual’s carers involved with the individual is encouraged. Social Security Scotland would recommend seeking advice from the wider clinical team who support the patient, particularly in complex and challenging cases.
If a clinician continues to have an unresolved query regarding a specific situation or set of circumstances, Social Security Scotland cannot discuss this but where appropriate they can recommend the clinician contacts the Chief Medical Officer's office who may be able to provide additional support in complex cases.
Yes. You need to seek and obtain valid informed consent from the patient or their representative, to share their personal/sensitive information securely with Social Security Scotland.
Social Security Scotland can only process a special rules application once they have received both an application form and a BASRiS or equivalent clinical judgement of terminal illness. For awards that have moved from DWP, Social Security Scotland only need a BASRiS or equivalent clinical judgement of terminal illness.
Social Security Scotland may require further information from RMPs/RNs who have completed a BASRiS before making a decision on the application. Equally, a Social Security Scotland clinical practitioner will contact a RMP/RN who has not yet provided a BASRiS for a patient who has applied for disability assistance under the special rules. Individuals who apply under the special rules can ask Social Security Scotland to contact their preferred named RMP/RN to obtain a BASRiS. In these circumstances, Social Security Scotland ensure they have the individual’s consent to contact their preferred named clinician.
The only situation where consent of an individual is not required is where the BASRiS is being completed without their knowledge because alerting them to the terminal nature of the condition would be considered harmful to their mental and/or physical health.
View Annex A, Section 3 of the CMO Guidance for more detail
When having the initial conversation with the patient you will request their consent to complete the BASRiS form and send it to Social Security Scotland. This is informed consent. However, should you, at a later date, need to send any additional information, you would need to request consent again from the patient, as not doing so would mean you only had implied consent.
You need to seek and obtain valid consent from the patient, or the representative acting on their behalf, 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. You may wish to use the text below to record the consent in the clinical records
"The patient or representative (name and relationship of a representative) has agreed to the sharing of their clinical and care information with Social Security Scotland for the purposes of accessing fast tracked disability benefits under special rules related to terminal illness.”
Yes, if the person has capacity. Use sensitive communication skills to convey implications of the illness, such as its life limiting nature. It would only be in very extreme situations that this communication would not take place. Acting in the best interests of the patient, this may be withheld from them, where it is thought that it would cause serious harm to their mental and or physical/health.
Please see Annex A, Section 7 of the CMO Guidance for more information
No, as long as the clinician is completing a BASRiS form in accordance with the Chief Medical Officer's guidance. This includes seeking their patient's consent to complete a BASRiS (and recording this in the patient's clinical records. The patient does not need to be physically present when the clinician completes the BASRiS. The clinician must ensure they record the date of the clinical judgement of terminal illness on the form – please note this date may be earlier than the date the form is completed and signed.
Yes, view the patient leaflets for each benefit.
In wider communications, Social Security Scotland will be clear that having a chronic illness does not necessarily mean an individual meets the Scottish terminal illness definition. Similarly, communications will include that a disease must be:
The individual can apply for disability assistance using the standard application route. They can find further information on mygov.scot for:
The Social Security (Scotland) Act 2018 requires that it is for registered medical practitioners and registered nurses to use their clinical judgement to decide whether the illness is terminal. If the clinician declines to complete the BASRiS form as they do not consider that the patient meets the required criteria, as set out in the Chief Medical Officer's guidance, the individual can apply for disability assistance using the standard application route.
However, if an individual considers that they may be terminally ill because their condition has deteriorated with time, then they can approach a clinician involved in their care to enquire as to whether a BASRiS form is appropriate.
The person can also ask for a second opinion from a relevant doctor or nurse who is able to sign the BASRiS form. The Charter of Patient Rights and Responsibilities required by the Patient Rights (Scotland) Act 2011 says, “You can ask for a second opinion before you make a decision about your care and treatment, if you think you need it. Where possible, your request will be met.” See the Health Rights Charter on the gov.scot website
If agreed, a second opinion could involve significant time delays to the application process.
The General Medical Council’s Guidance on Duties of doctors registered with the General Medical Council also states that, “In providing clinical care you must respect the patient’s right to seek a second opinion.” See the General Medical Council's ethical guidance for doctors
However, there is no legal right to a second opinion.
Individuals wishing to request a BASRiS form should approach their lead healthcare professional. This could be a General Practitioner, clinician, consultant or registered nurse.
View Requesting a BASRiS form for more information.
In order to be identified as supporting information for fast-tracked processing under the special rules, it is essential that different versions of the BASRiS form are sent to Social Security Scotland in the right way.
The completed BASRiS web form should be submitted online via the digital portal. This is the quickest way to send a BASRiS form to Social Security Scotland.
If using the editable pdf version, this should be emailed to Social Security Scotland – email addresses are clearly stated at the bottom of the BASRiS and the form is marked ‘FOR EMAIL USE ONLY’ at the top.
The completed paper BASRiS form should be posted to Social Security Scotland at this address:
BASRiS Form
PO Box 27165
GLASGOW
G4 7BR
Doctors who have a current full registration with the General Medical Council and are licensed to practise will be able to sign a BASRiS form. If a doctor is not a specialist or a General Practitioner, they need to consult with/involve their educational and/or clinical supervisor before signing the form.
The Registered Medical Practitioner should also fulfil the 5 criteria below:
The Registered Nurse should fulfil the 5 criteria below:
(see NMC code)
You should record the date you made the clinical judgement that your patient meets the Scottish definition of terminal illness. This date may be earlier than the date you complete and sign the form.
You should complete the BASRiS as soon as you make the clinical judgement but even if you complete it on a later date, you must record the date on which you made the clinical judgement that your patient met the Scottish definition of terminal illness.
Yes, where an individual has stated that they do not wish the BASRiS form to be completed and submitted to Social Security Scotland, the BASRiS form must not be completed.
The individual could also be directed to contact Social Security Scotland so that they can apply for disability assistance through the standard application route.
Difference between Welfare Guardian, an Appointee and third party involvement
A Guardian or Power of Attorney could only request a BASRiS where they have been awarded specific welfare powers that authorise them to provide consent to a registered medical practitioner or registered nurse on the individual’s behalf.
No, an appointee only has authority to step into the client's shoes in their interactions with Social Security Scotland. It does not allow them to deal with any other aspect of the person’s affairs. Therefore they could make an application for disability assistance on behalf of the client and receive the money for them but the appointment does not give them legal authority to deal with their registered doctor/nurse or give consent on their behalf. This would require a Guardianship order that grants welfare powers to be in place. Further information on Guardianship.
Yes, if the application is in the individual’s name, and the individual has given their consent for an application for disability assistance to be made. The payment will be to the individual and all further communication will be with the individual.
The individual can give the third party consent to apply for disability assistance even if they do not know they have been diagnosed with a terminal illness. This could be because it would be harmful to them if they were told how serious their condition is.
In this case a third party, such as a relative, friend or health and social care professional, would be anyone acting in the best interests of the individual.
No, the person completing the form is certifying whether a person is terminally ill according to the Scottish definition and in line with the Chief Medical Officer’s guidance. Clinicians can only make clinical decisions. Social Security Scotland will need to check other eligibility criteria such as residency and age before making a decision to award disability assistance.
No, Social Security Scotland will check residency status.
Independent General Practitioner contractors and private General Practitioners, as well as General Practitioners and Registered Nurses employed by the independent contractor and private General Practitioner practices, can submit a claim on behalf of the General Practitioner practice.
Registered medical practitioners and registered nurses who are employed by a third sector organisation (for example a charity) can submit a claim on behalf of that organisation.
Details of when a fee can be claimed by medical staff are contained in the Terms and Conditions for Medical Staff in Scotland.
The clinician must complete and return the BASRiS form as well as the BASRiS Payment Form to be able to claim a fee. A fee cannot be claimed for a verbal confirmation of the patient’s terminal diagnosis over the phone, unless this is followed up by submission of a BASRiS form within 28 days.
To claim a fee for completing the BASRiS, complete and submit the Payment Form online. Or, download an editable BASRiS Payment Form and email this to Social Security Scotland at the same time as emailing a completed editable (pdf) BASRiS form.
Alternatively, complete the Payment Form by hand and post it to:
BASRiS Fee Payment Form
PO Box 27165
GLASGOW
G4 7BR
This will be processed upon receipt of the BASRiS form and BASRiS Payment form within 30 days.
Any adult with parental responsibilities and rights or a guardian, can apply for Child Disability Payment (CDP) on a child’s behalf if the child is under 16 and living in Scotland. Social Security Scotland will pay CDP until the child is 18. They can sometimes continue making payments after the child is 18. When a young person with a terminal illness in receipt of CDP reaches age 16 to 18, they can give their consent to have their award automatically transferred to Adult Disability Payment (ADP).
In Scotland, the general position is that a young person aged 16 years and above is presumed to have the capacity to enter into a transaction - Age of Legal Capacity (Scotland) Act 1991 . 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.
Where a BASRiS form has been completed this will have been noted in patient’s medical record.
Once a patient has a completed a BASRiS form and they have satisfied Social Security Scotland’s eligibility criteria (e.g. residency status, age, etc.), there will be no further assessment required by Social Security Scotland to access disability assistance through Special Rules for Terminal Illness in Scotland. This is a lifetime award which will only be reviewed if the individual’s circumstances change.
The process for diagnosing terminal illness for the purposes of applying for disability assistance in Scotland, as laid out in the Chief Medical Officer's guidance, applies to all – irrespective of criteria such as age and residency status, provided they live in Scotland and they are not subject to immigration control. This includes people with no fixed address or who are homeless. However, there is no requirement for clinicians to determine these factors, as these checks will be undertaken by Social Security Scotland.
The Scottish definition relates to disability assistance in Scotland only. It has replaced the Department for Work and Pension’s definition as each of Scotland’s new disability benefits have launched.
For benefits administered by the UK Government, the DWP definition of terminal illness (12-month life expectancy) applies.