Terminally-ill patients need more than treatment

Social Security Scotland’s approach to terminal illness represents a more compassionate system – one that clinicians could actively champion says Social Security Scotland’s Chief Medical Advisor, Professor Paul Knight.

“A terminal illness diagnosis is one of the hardest moments a person and their family can face.

Initial shock is often followed by grief, fear, and a period of emotional adjustment, as everyone affected comes to terms with the loss of health and an uncertain future. Family members may simultaneously be processing their own distress while taking on caring roles, advocating within health systems and trying to hold everyday life together.

During this time, practical concerns – including finances, employment, benefits and future planning – can add a significant layer of stress.

As a hospital consultant for over three decades, I know that having a terminal illness isn’t just about an individual’s health – it can also cause serious worries about finances that affect whole families. 

People may need to give up work, leading to a loss of income at a time when they’re facing increased costs such as travelling to multiple appointments and paying for the extra electricity and gas they need to stay warm and run specialist equipment. 

Financial support to help cover these costs is available but can only be accessed with the help of a registered doctor or nurse. 

In Scotland, anyone with a terminal illness – no matter their income or savings – can apply for Child Disability Payment, Adult Disability Payment or Pension Age Disability Payment. 

Social Security Scotland has a dedicated fast-track route for applications from terminally-ill people, with awards given at the highest payment rate. 

Crucially, people do not need to have a fixed life expectancy to be regarded as terminally ill within the Scottish benefits system. 

This differs from the Department for Work and Pensions where people are only classed as terminally ill if they are expected to live for 12 months or less. 

Access to Scotland’s fast-track application process and automatic entitlement to the highest possible payment depends on one vital step: the completion of a Benefits Assessment under Special Rules in Scotland (BASRiS) form by a registered nurse or medical practitioner involved in the patient’s care. 

This form confirms that a patient is terminally ill and without it, patients cannot be fast-tracked — these delays could mean unnecessary distress.

I urge clinicians to complete the BASRiS form as soon as a terminal illness diagnosis is made. If a patient hasn’t applied for benefits, Social Security Scotland will invite them to apply, ensuring support reaches them without delay.

Importantly, if a patient is not aware of their diagnosis, this can be noted on the form. Social Security Scotland does not disclose prognosis information when contacting patients.

Scotland’s Chief Medical Officer issued guidance for clinicians which can be found online, with additional guidance available on the Social Security Scotland website.  A dedicated helpline for assistance is also available to clinicians on 01382 931060.

I am encouraging clinicians across Scotland to familiarise themselves with the BASRiS process and make sure no patient misses out on the vital support they need.

Your role is crucial — and your actions can spare families immense hardship at one of the most challenging times of their lives.”

Professor Paul Knight is Social Security Scotland’s Chief Medical Advisor and has over 30 years’ experience working with older people. He was formerly a consultant geriatrician at the Glasgow Royal Infirmary.

Further information on BASRiS

Social Security Scotland delivers 17 benefits to the people of Scotland. These include Child Disability Payment, Adult Disability Payment and Pension Age Disability Payment. 

In Scotland, there is no fixed life expectancy to be eligible for disability assistance under the special rules for terminal illness. 

A registered medical practitioner or registered nurse involved in the patient’s care should complete a Benefits Assessment under Special Rules in Scotland (BASRiS) form to confirm a patient has a terminal illness.

The BASRiS form replaces the SR1 and DS1500 for disability assistance delivered in Scotland; however, SR1 or DS1500 may still be accepted if already completed.

Clinicians must take account of the Chief Medical Officer’s guidance, which is a legal requirement when certifying terminal illness and completing the BASRiS form.

Clinicians with SWAN (Scottish Wide Area Network) access can complete a BASRiS webform, the quickest submission method.

An editable PDF or paper version of the BASRiS form is available for those without SWAN access.

A new BASRiS form (released 15 December 2022) includes a required field for the date of clinical judgement, which enables Social Security Scotland to backdate payments.