Guidance

The ‘Special Rules’: how the benefit system supports people nearing the end of life

Updated 20 September 2024

Find out about getting benefits if you’re nearing end of life.

Resources for healthcare professionals to promote the special rules for end of life.

What the Special Rules are for

The Special Rules allow people nearing the end of life to:

• get faster, easier access to certain benefits
• get higher payments for certain benefits
• avoid a medical assessment

An adult or child is nearing the end of life when they are likely to have less than 12 months to live.

If a person is likely to have less than 12 months to live, they can make a fast-tracked claim to the following benefits (for which they are eligible):

• Personal Independence Payment (PIP)
• Universal Credit (UC)
• Employment and Support Allowance (ESA)
• Disability Living Allowance (DLA) for children
• Attendance Allowance (AA)

The role of clinicians

Clinicians can be asked to provide medical evidence on an SR1 form to support a benefit claim made under the Special Rules.

The SR1 form has replaced the DS1500 form.

A clinician should complete an SR1 form promptly if they believe that their patient:

• has a progressive disease, and
• as a consequence of that disease, it would not be a surprise if their patient were to die within 12 months

A clinician may be:

• a GP
• a consultant
• a specialty doctor
• a hospice doctor, or
• a senior specialist nurse (such as a clinical nurse specialist, advanced nurse practitioner or similar)

The Special Rules apply to anyone who may be nearing the end of life due to age or illness. There are no negative consequences for the clinician or patient if a patient who claims under the Special Rules lives longer than expected.

Aligning welfare and health services

The 12-month, end of life approach used in the Special Rules means that the DWP is aligned with the NHS, where the definition of ‘end of life’ states that ‘patients are approaching the end of life when they are likely to die within the next 12 months’.

Clinicians are encouraged to identify patients who have reached the final year of their life and use a holistic approach to consider the support that their patient may require at this point. The alignment of the definition across welfare and health services allows clinicians to include conversations about financial support in wider conversations about ‘what matters most’ to their patient, thus being more responsive to their needs.

Providing medical evidence using the SR1 form

It is important that you know about your patient’s condition.

It may be appropriate to complete an SR1 form:

• to encourage your patient to see what financial support they may be entitled to
• following a conversation about advance care planning
• as part of an assessment about current social and financial issues
• if requested by your patient or their representative

Patients who may not know the true nature of their illness

If a patient asks for an SR1 form to be completed, please do not assume that they understand the Special Rules criteria or that these criteria may apply to them. It could be an opportunity to explore their understanding of their condition, begin a discussion about advance care planning or document ‘what matters most’ to them. All claims made under the Special Rules are processed in a compassionate and appropriate manner.

Completing the SR1 form

The SR1 form asks for:

• diagnosis / diagnoses and other relevant conditions
• date of diagnosis
• whether your patient is aware of their diagnosis and prognosis
• date your patient is thought to meet the Special Rules*
• clinical features that indicate a severe progressive condition (for example, investigation results, staging if appropriate etc.)
• information about treatment that has been received, is ongoing or is planned
• clinician’s details including GMC / NMC number

The date that your patient was first thought to meet the Special Rules criteria may be the date of diagnosis, the date the form is being completed or some alternative date in between. Providing this information will allow the DWP to ensure your patient receives payment from the correct date.

You do not need to give a specific prognosis. Please use language that you would normally use when communicating with other clinicians.

Please also provide your GMC / NMC number as the form cannot be accepted without this information.

Using clinical indicators

Determining life expectancy in these circumstances is challenging.

The following indicators may suggest that a patient is eligible under the Special Rules:

• advanced, progressive illness
• rapid or gradual deterioration of incurable or terminal condition
• worsening symptoms despite optimal treatment or management
• (severe) degenerative condition
• metastatic disease
• inoperable cancer
• severe frailty
• death is imminent, death is inevitable
• high risk of sudden death with an underlying deteriorating condition

Patients may be eligible for the Special Rules when receiving ongoing or palliative treatment. In some circumstances, there may not be any treatment options available that would significantly alter prognosis.

Your patient’s claim is likely to be helped if you include relevant information such as:

• no or poor response to treatment
• palliative care or palliative treatment in any form including palliative chemotherapy, immunotherapy or radiotherapy
• receiving symptom control and / or psychosocial support only
• no further treatment planned / available
• treatment is declined
• treatment ongoing but unlikely to alter prognosis

The Special Rules criteria do not only apply to patients with cancer. They also apply to other severe, life-limiting conditions, such as:

• end-stage respiratory disease (e.g. COPD, pulmonary fibrosis)
• end-stage heart disease
• end-stage dementia
• severe frailty
• end-stage liver disease
• end-stage renal failure
• end-stage neurological disease (e.g. motor neurone disease, multiple sclerosis, Huntington’s disease)
• end-stage cystic fibrosis

This list is not exhaustive.

You can find information about general or disease-specific indicators, advance care planning, palliative care initiatives and NICE guidelines on these websites:

• SPICT – Supportive and Palliative Care Indicators Tool
• The Gold Standards Framework Proactive Identification Guidance (PIG) Proactive Identification Guidance)
• Universal Principles for Advance Care Planning (ACP)
• The Daffodil Standards
• NHS England » Renewing our ambitions for palliative and end of life care
• NHS England » Palliative and end of life care
• Quality statement 1: Identification
• NICE Guideline for End of Life Care: Service Delivery
• What Matters to You Conversations

What we will do if we need to clarify any information

The DWP relies on the judgement of clinicians when they complete an SR1 form.

However, a clinician may be contacted by a practitioner working for one of our clinical assessment providers if:

• information provided on an SR1 form needs to be clarified to help with a decision about the claim, or
• an individual has made a claim under the Special Rules but has not submitted an SR1 form and clinical information is required to support the claim

Because we need to deal with these claims urgently, the practitioner will usually make contact by telephone.

Who can make claims on behalf of patients?

For claims to UC and ESA, only an appointee or a person who has power of attorney can make a third-party claim on the patient’s behalf.

For claims to DLA, PIP and AA, any person representing the patient can make a third-party claim on their behalf, even if the patient is unaware that a claim is being made.

Claiming a fee

If you are a GMC registered doctor, you can claim a fee for completing an SR1 form by completing a separate fee form.

Returning the SR1 form

You can return the SR1 form through the NHS Spine Portal, by email or by post.

Through the NHS Spine Portal

This service is available from the NHS Portal on your desktop. You will need an NHS smartcard to access the service. Once you have accessed the NHS Portal, click on ‘Launch Digital SR1 Service’ and complete the SR1 form online.

Once you have submitted the SR1 form online, you can download a copy of the form and save it to your patient’s medical record.

You can also download a fee form, if required. This can be returned by post to:

Personal Independence Payment (10)
Mail Handling Site A
Wolverhampton
WV98 1AE

By email

To get a copy of the electronic version of the SR1 form (with or without a fee form), please send an email from your secure email address to form.e-SR1@dwp.gov.uk with the following information:

• surgery / hospital / office postal address
• telephone number
• request for SR1 form
• request for fee form, if necessary

Secure email addresses end in @nhs.net, @nhs.uk, @wales.nhs.uk, @nhs.scot and gov.uk

The electronic SR1 form can be saved to your desktop.

When required, complete the electronic SR1 form (with or without fee form) and email it to form.e-SR1@dwp.gov.uk using your secure email address.

Do not encrypt any part of the email. Any email that does not come from a secure email account will be automatically deleted.

No signature is required on either form for this method of return.

By post

Please do not print the electronic version of the SR1 form to return by post.

Requests for a book of paper copies must be made using the order form.

If you have completed a paper copy of the SR1 form or fee form, please sign it. Only original signed copies of these forms will be accepted by post.

There are 2 options for returning the forms to us:

• give the SR1 form to the person who requested it and return the fee form separately to us, or
• post the completed SR1 form and fee form directly to:

Personal Independence Payment (10)
Mail Handling Site A
Wolverhampton
WV98 1AE

When returning SR1 forms, please use a separate envelope for each patient. Please do not staple documents together.