This guidance is for clinicians who have a patient with a terminal illness and need to complete a Benefits Assessment for Special Rules in Scotland (BASRiS) form on their behalf. The BASRiS form is supporting information for Social Security Scotland to make a decision for disability assistance.
These frequently asked questions have been put together in one place so that you can find the answers you need easily.
Q 1. Why is this guidance needed?
This guidance is needed because some disability benefits, such as Personal Independence Payments (PIP), have now been devolved to Scotland and will be administered by Social Security Scotland with different rules.
The guidance sets out the new rules for accessing those disability benefits where the potential recipient is terminally ill (Benefits Assessment under Special Rules in Scotland (BASRiS)). The guidance introduces:
• a new definition of terminal illness for Scottish social security purposes
• a framework to support those making a clinical judgement whether people who are approaching the end of their lives may access disability benefits under the BASRiS rules.
Other benefits, such as Universal Credit and Employment Support Allowance, have not been devolved and continue to be administered on a UK basis, by the Department for Work and Pensions, following existing rules and definitions.
Q 2. Who is this guidance for?
This guidance has been written for doctors and nurses who may provide care for people towards the end of life, and who therefore 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.
Q 3. What is this guidance about and its purpose?
The new definition of terminal illness applies to some but not all disability benefits which a person may be applying for in Scotland. This guidance explains when and how this new definition should be used. The purpose of this guidance is to help doctors and nurses assess whether someone meets the definition of 'terminally ill' and therefore is eligible to access disability benefits more easily, quickly and at the highest rates.
Q 4. What is the new definition of terminal illness?
The new definition is included in the Social Security (Scotland) Act 2018, and slightly amended by the Social Security Administration and Tribunal Membership Act 2020, it 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 included that ‘appropriate healthcare professional’ must include registered medical practitioner and registered nurse.
This guidance supports clinicians to interpret and apply this 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 for more detail.
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/conditions ; Dementia; rare conditions or diseases; combinations of conditions.
o It applies to children as well as adults.
Q 5. What does this guidance contain and how is it structured?
This guidance contains the information which doctors and nurses 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 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 new definition.
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 legislative underpinning, 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.
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 of how the definition would apply to different individuals.
Q 6. Is eligibility for BASRiS affected where the individual has a drug or alcohol addiction and this has impacted on the state of the progressive disease?
No. In deciding whether an individual meets the criteria for BASRiS clinical decisions should focus on the individuals’ symptoms, clinical indicators and whether the individual requires expedited access to benefits, and not possible causes of these.
Q 7. Frailty
Frailty is not classified as a 'disease' at present, but a condition. As legislation (Social Security (Scotland) Act 2018 has a very specific definition of terminal illness for the purpose of considering an application under special rules of 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.
Q 8. Reporting changes in circumstances e.g. a person with end stage kidney disease who receives a renal transplant
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, to those acting on behalf of the individual to notify change of circumstances.
Failing to notify Social Security Scotland about a change in any of those circumstances in that way may be an offence.
Q 9. What is BASRiS?
BASRiS stands for Benefits Assessment under Special Rules in Scotland. It replaces the DS1500 for some disability benefits in Scotland, If, as defined in the Chief Medical Officer’s Guidance (Scotland), an individual has a terminal illness, a registered doctor or registered nurse can complete a BASRiS form which will support an application for disability assistance under special rules.
Q 10. Which benefits require a BASRiS form?
The new Scottish disability benefits:
Child Disability Payment which replaces Disability Living Allowance (Child) in Scotland.
Adult Disability Payment which replaces Personal Independence Payment in Scotland.
Pension Age Disability Payment which will replace Attendance Allowance in Scotland.
Q 11. What is DS1500?
DS1500 is the form clinicians can complete if a patient has a terminal illness as defined by the Department for Work and Pensions Guidance.
Q 12. Which benefits still require a DS1500?
A DS1500 should continue to be completed for an individual where the relevant new Scottish benefit has not yet launched.
The Department for Work and Pension’s terminal illness definition will continue to be required for Scottish clients accessing any reserved benefits (benefits still administered by the Department for Work and Pensions) where the client is terminally ill and eligibility is related to them being diagnosed as such. The Chief Medical Officer’s guidance does not apply to these benefits:
Employment Support Allowance
Universal Credit
Where a client already has a BASRiS form the Department for Work and Pensions 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 Department for Work and Pensions rules.
Q 13. Will some people need both BASRiS and DS1500?
No. If an individual already has a DS1500 they would automatically be eligible under BASRiS and do not require a BASRiS form to be completed. Where a client already has a BASRiS form the Department for Work and Pensions 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 Department for Work and Pensions rules.
Q 14. If an individual already has a DS1500 would they need to also request a BASRiS?
No. Individuals who have been awarded benefits previously using a DS1500 will be automatically eligible under BASRiS, so there would be no need to also request a BASRiS. If they do not already hold a DS1500, then a BASRIS should be completed.
Q 15. Is there an ‘expert point of contact’/ helpline to support clinicians making a decision about eligibility for BASRiS on a complex/challenging case?
Social Security Scotland will provide a helpline whereby a clinician completing a BASRiS form can seek assistance regarding how they can access the 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 specific situation or 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.
Q 16. Do I need the consent of an individual to complete BASRiS?
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.
The only situation where consent of an individual is not required is where the BASRiS is being completed without the knowledge of the individual as alerting them to the terminal nature of the condition would be considered ‘harmful’ to the individual.
View Annex A, Section 3 of the guidance
Q 17. How do I ensure I have informed consent of an individual to complete BASRiS?
When having the initial conversation with the patient you will request their consent to complete the BASRiS form and send the completed form to Social Security Scotland. This is informed consent. However, should you, at a later date, need to submit any additional information, you would need to request consent again from the patient, as without doing so would mean you only had implied consent.
Q 18. What should clinicians record in clinical records and why?
You need to seek and obtain valid consent from the patient 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. 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.”
Q 19. Do I have to tell the person he/she has a terminal illness?
Yes, if the person has capacity, using sensitive communication skills to convey implications of the illness, such as life limiting nature. It would only be in very extreme situations that this communication would not take place. For example, this may be withheld from a patient, only where it is thought that it may be harmful to the patient and in the patient’s best interests.
Please see Annex A, Point 7 of the guidance for more information.
Q 20. Does the patient need to be with the clinician in person to have a BASRiS form signed?
No, as long as the clinician is completing a BASRiS form in accordance with the Chief Medical Officer's guidance, including seeking the consent of the patient, (and recording this in patient’s clinical records), the patient does not need to be physically present when the clinician completes the form.
Q 21. Is there information for patients regarding eligibility for BASRiS which I could direct them to?
Yes, view the patient leaflet.
In wider communications about the new definition, Social Security Scotland will be clear that having a chronic illness does not mean an individual meets the new terminal illness definition. Similarly communications will include that a disease must be:
• advanced and progressive or with risk of sudden death, AND;
• not amenable to curative treatment; or treatment is refused or declined by the patient for any reason, AND;
• is leading to an increased need for additional care and support.
Q 22. What if an individual has a condition that impacts on the day to day living and/or mobility but they are not eligible for a BASRiS?
The individual can apply for disability assistance using the standard application route. They can find further information here: [this will be added when available]
Q 23. What if a person disagrees with the decision of a clinician?
The Social Security (Scotland) Act 2018 requires that it is for doctors and 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 fulfils the required criteria, as set out in the guidance, to the best of their knowledge and belief, the individual can apply for disability assistance using the standard application route.
In addition, if they consider that their condition has deteriorated with time, then the individual can approach a clinician involved in their care to request a BASRiS form.
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 doctor 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.
Q 24. How can I access a BASRiS form?
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.
Q 25. Where do I send a BASRiS form once completed?
The completed BASRiS form should be sent to Social Security Scotland at this address:
BASRiS Form
PO Box 27165
Glasgow
G4 7BR
Q 26. Which doctors can sign a BASRiS form e.g. FY2
Doctors who have a current full registration with the General Medical Council and licensed to practise will be able to sign the BASRiS forms. If a doctor is not a specialist or a General Practitioner, they would 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:
• 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
Q 27. Which nurses can sign a BASRiS form?
The Registered Nurse should fulfil the 5 criteria below:
• 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 Nursing and Midwifery Council
(see NMC code)
Q28. What date should I record on the BASRIS Form?
You should record the date you made the clinical judgement that your patient meets the definition of terminal illness. You should complete the BASRiS as soon as you make the clinical judgement, but if you complete it on a later date, you must put the date on which you diagnosed the terminal illness.
Q 29. Can an individual choose not to have a BASRiS form?
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 normal route.
Difference between Welfare Guardian, an Appointee and third party involvement
Q 30 Who, other than the individual, or in the case of a child their parent, can request BASRiS?
A Guardian or Power of Attorney could only request a BASRiS where they have been awarded specific powers in order to give a Doctor consent.
If a Guardian or a Power of Attorney has powers (in each case this will depend on the specific order) to submit an application for disability assistance and in their application they select ‘Special Rules Terminal Illness’ this will trigger Social Security Scotland to request BASRiS information from the clinician named on the application form.
Q 31. Can an Appointee request a BASRiS form from a clinician?
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 it would not allow them to deal with their doctor or give consent. However, they could submit an application under Special Rules for Terminal Illness to Social Security Scotland who would then initiate receipt of BASRiS information by contacting the clinician named on the application form directly.
Q 32. Can a third party other than a parent, Appointee, Power of Attorney or Welfare Guardian submit an application for Disability Assistance on behalf of an individual?
Yes, if the application is in the individuals 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.
In this case a third party would be anyone acting in the best interests of the individual for example, relative, friend, health and social care professional.
Q 33. Is the clinician completing a BASRiS form making a benefit entitlement decision?
No, the person completing the form is certifying whether a person is terminally ill 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 a residency and age before making a decision to award disability assistance.
Q 34. Is it the responsibility of the clinician signing a BASRiS form to check residency status?
No, Social Security Scotland will check residency status.
Q 35. Who is eligible to claim a fee for completing a BASRiS?
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.
Q 36. How do I claim a fee for completing a BASRiS?
Request a BASRiS Fee form
Complete the form 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 Fee form within 30 days.
Q 37. When is an individual a child?
With regard to receiving disability benefits the Scottish equivalent of Disability Living Assistance (child), Child Disability Payment, can continue to age 18 but new claims can only be made up to age 16. New claims from age 16 onwards will be for the Adult Disability Payment.
Q 38. When is consent of a child needed?
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 . 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.
Q 39. Is there a way to check if a BASRiS form has been completed for an individual? (Patients, family and other professionals might need to do this.)
Where a BASRiS form has been completed this will have been noted in patient’s medical record.
Q 40. What assessment will be required?
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.
Q 41. Will homeless people be able to access disability assistance through the Special Rules for Terminal Illness route?
The process for diagnosing terminal illness for the purposes of applying for Scottish equivalents of disability assistance, 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.
Q 42. Does the new definition of terminal illness in the CMO guidance replace other definitions of terminal illness which are in use?
The new definition relates to disability assistance in Scotland only. It will replace the Department for Work and Pension’s definition as each of Scotland’s new disability benefits launch in turn.
There are however other legislative definitions of terminal illness (e.g. Carers (Scotland) Act 2016.) which remain unchanged.