Social Security Experience Panels - Adult Disability Payment: mobility component eligibility criteria

Moving Around criteria

Panel members were asked for their views on the Moving Around criteria. This included any positives or negatives that they saw, their thoughts on the distances used and their own ideas for how a person's mobility needs could be considered differently. Participants were also asked about any hidden costs to mobility that they feel Social Security Scotland should be aware of.

The eligibility criteria for the Moving Around activity is set out below, along with the number of points for each descriptor:

Descriptor	Points
a. Can stand and then move more than 200 metres, either aided or unaided.	0
b. Can stand and then move more than 50 metres but no more than 200 metres, either aided or unaided.	4
c. Can stand and then move unaided more than 20 metres but no more than 50 metres either aided or unaided.	8
d. Can stand and then move using an aid or appliance more than 20 metres but no more than 50 metres, either aided or unaided.	10
e. Can stand and then move more than 1 metre but no more than 20 metres, either aided or unaided.	12
f. Cannot, either aided or unaided,— (i) stand, or (ii) move more than 1 metre.	12

There have been some changes to the Moving Around element of the decision-making process which were introduced as part of ADP. These include looking at a person's ability to stand and move when outdoors, without symptoms of severe discomfort, pain or fatigue. Breathlessness may be considered as a symptom of severe discomfort. It also considers how quickly someone can walk and the risk of falls, and the types of surfaces that someone might encounter outdoors, such as kerbs and pavements.

Although these changes were active at the time of the first phase of research, the information was not yet available for inclusion in the research guides that participants were provided. Where relevant, this has been noted to provide context to the comments made by participants from the first phase of research.

General views on the Moving Around criteria

Survey respondents were asked to provide some general feedback on the Moving Around criteria based on:

• How suitable they thought the descriptors were for understanding someone's ability to move around.
• How clear and easy to understand they found the descriptors.
• How easy they found it to choose a descriptor which reflects their own level of mobility.

Suitability

Almost half of respondents (49 per cent) disagreed that the descriptors were suitable for understanding someone's ability to move around, with a quarter (25 per cent) strongly disagreeing with this statement. However, just over a third (36 per cent) agreed that the descriptors were suitable and 15 per cent had no strong opinion.

Table 5. The descriptors are suitable for assessing someone's ability to move around (n=191)

	% of respondents*
Strongly agree	6
Agree	30
Neither agree nor disagree	15
Disagree	24
Strongly disagree	25

*Figures may not add to 100 per cent due to rounding.

Understanding

Almost half of respondents (47 per cent) thought that the descriptors were clear and easy to understand. Overall, responses were mixed with around a third (32 per cent) disagreeing with the statement and a fifth (21 per cent) neither agreeing nor disagreeing.

Table 6. The descriptors are clear and easy to understand (n=189)

	% of respondents*
Strongly agree	10
Agree	37
Neither agree nor disagree	21
Disagree	19
Strongly disagree	13

*Figures may not add to 100 per cent due to rounding.

Using the descriptors

Half of respondents (50 per cent) disagreed that they would find it easy to choose a descriptor or descriptors that reflected their own level of mobility, with a quarter (25 per cent) strongly disagreeing. Two-fifths (38 per cent) agreed and just over one in ten (12 per cent) neither agreed nor disagreed.

Table 7. Thinking about my own level of mobility, it is easy for me to choose a descriptor (or descriptors, where a condition fluctuates) that reflects this. (n=187)

	% of respondents*
Strongly agree	9
Agree	29
Neither agree nor disagree	12
Disagree	25
Strongly disagree	25

*Figures may not add to 100 per cent due to rounding.

Positive feedback

Descriptors are clear and easy to understand

A few interview participants provided positive feedback, noting that they found the criteria to be clear and easy to understand. One participant felt that the wording, explanation and layout were clear.

"It is clearer than the PIP form and it does make a clear difference between can you do it unaided, or can you do it aided? […] So, it is better in that respect and it's better laid out because it tells you how many points each one gets and it's spaced out between them. A big problem with PIP is that it's just one big massive block of writing, at least this is spaced out a bit." (Interview participant)

Others stated that they found the distances used in the different descriptors helpful as they provided a clear measure to compare their mobility against.

"The positive is that there is a measure that can be used, whereas just going on impressions or thoughts is very difficult, so it's actually defined […] I can see the benefit of having a measurable distance." (Interview participant)

Use of distances

Many participants highlighted areas of the criteria which they thought did not work well or needed improvement. This included the use of distances, which was criticised for a variety of reasons across a range of different topics.

Revising distances

Many participants stated that they thought the distances used were too short, and so felt that some people may be excluded from the support which they need. Some suggested that there should be automatic qualification for mobility support for all people who cannot move more than a lower limit (e.g. 10 or 50 metres).

"But as a person looking just at the broad criteria it seems that you have to be virtually completely immobile in order to qualify for the higher rate of mobility, which seems a little harsh. Personally, I would think that somebody who is unable to get more than 50 metres unaided or with a stick or so on, should really be getting quite a big help with their mobility needs." (Interview participant)

"To me, surely you just put on a lower limit where if the person can't walk unaided for more than 10 metres then, surely they qualify for some sort of mobility component." (Interview participant)

A few participants suggested that distances should be removed altogether in favour of a broader question framed around whether or not someone needs assistance with their mobility.

"I think that's unhelpful, I think it's just, do you need any sort of help moving around? I don't think it should be can you do 50 metres to 100 metres? You can either do it or you can't. So you're either on crutches or in a wheelchair, or some other physical disability which means that you can't do it, so there shouldn't be a limit: you either can or you can't." (Interview participant)

Variable mobility and set distances

A few participants and respondents commented that their mobility can vary from day to day, making set distances an unsuitable way of assessing how far they can move. One respondent commented that they felt these variations in ability were not properly considered during DWP assessments.

"Personally, and mainly based on DWP assessments, variability in my ability was not considered. Aiming to walk a certain distance each day does not mean that this can always be achieved and should not be assessed as such." (Survey respondent)

Understanding distances

Many participants stated that they found the distances abstract and hard to understand, making it more difficult for them to match the descriptors used to their own level of mobility.

"It is really difficult. I'm not really sure of the distances, like, how far? Like, the window to the door there, how far is it to there?" (Interview participant)

"I just got lost in it. It's quite complicated and also, like it says 200 metres and things – personally, that means nothing to me. So, 200 metres, I wouldn't have a blind clue because I don't really have a picture in my head of how much 200 metres is." (Interview participant)

A few participants suggested that the distances would be more understandable if different units of measurement were used. One focus group discussed that feet would be more in line with standard UK measurements.

Participant 1: "I still don't really do metres."

Participant 2: "Metres is odd here seeing that most of the measurements here in the UK are feet and inches." (Focus group discussion)

One participant suggested using visual guides to help applicants visualise how far the distances are.

"Like, say if you put drawings on them and then they could sort of mark how far. I think that would be [the clearest way] because a lot of folk might not understand the words […] you could get diagrams of what folk could do." (Interview participant)

Use of DWP measurements

Finally, some participants commented that they felt the distances used in the criteria were only present because they had been carried over from DWP processes. These participants felt that this should be avoided in future, particularly where the rationale for Social Security Scotland using elements of the DWP decision-making process was not clear.

Participant 1: "Why do we have these ambiguous figures of 200 metres, of 50 metres? Why did these figures materialise? Where have they come from? They've come from somewhere, haven't they?"

Participant 2: "I think it comes from the DWP […] When creating this thing it's understandable to look at how the DWP did things. It makes sense. But it should be an example of what not to do." (Focus group discussion)

Accounting for additional factors

Many participants and survey respondents commented that, in addition to distance, other factors need to be considered within the decision-making process when looking at an individual's ability to move around. A variety of suggestions were made and are outlined below.

The majority of these suggestions (relating to types of surface, pain, fatigue, time and balance) are already reflected within the decision-making process used by Social Security Scotland, as outlined on page 18.

It is important to note that while details of these changes were not available at the time of the first stage of fieldwork in autumn of 2022, the survey that formed the second phase of research did outline the inclusion of these factors within decision-making processes. However, a significant number of survey respondents still mentioned these as areas of concern. The points below are therefore summarised from both stages of research.

Pain, consequences of moving and consistency

Many participants and survey respondents stated that there should be more consideration given to how a person feels while moving, for example if they experience pain. Some participants commented while they would be able to move the set distances, it would cause them considerable pain, which may be felt at the time of movement or over the following days.

"I could do distances. So, the distance is irrelevant for me. It's the awkwardness and the time consuming and the time around it, and the pain involved." (Interview participant)

"I'm always in pain but most of the time the pain is manageable, just about. But there are days where it's completely unbearable and I think that's a factor that should be taken into consideration as well. Rather than just can you walk 20 metres, what's the cost of you walking that 20 metres? Are you going to pay for it the next day in pain levels?" (Interview participant)

Although the decision-making process does consider the pain experienced by individuals when moving, participants and respondents still felt that there needed to be a better understanding of this.

"Questions should be clear that it means when you are in pain and/or discomfort when walking instead of asking if you can walk so many metres." (Survey respondent)

Suggestions included doing this either through some measurement of pain levels or through considering a person's ability to move consistently and on a regular basis, including the need for rest as a result of movement.

"Include a basic measurement of pain for each condition and activity e.g. 0-10 as practiced by NHS. This would enable the assessor to understand which activities can cause the most pain in relation each of the claimant's conditions." (Survey respondent)

"For someone with [multiple sclerosis] or in that kind of line, they might be able to do it today, but they can't do it tomorrow. Or they can do it today but they're in their bed three days on the back of it because they've pushed through. So, I think it needs to be in the broader sense can you do these things on a regular consistent basis, rather than as a one-off." (Interview participant)

As part of the follow-up survey, respondents were asked if they agreed with the criteria asking if they can do these things on a regular, consistent basis, rather than as a one-off. The majority of respondents (75 per cent) agreed with this suggestion.

Table 8. The criteria asking: "Can you do these things on a regular, consistent basis, rather than as a one-off?" (n=188)

	% of respondents*
Agree	75
Disagree	13
Neither agree nor disagree	12

*Figures may not add to 100 per cent due to rounding.

Surfaces

Some participants and survey respondents highlighted that it is important to consider the kind of surface a person is walking over, for example rough or uneven surfaces, or walking up an incline or stairs.

"None of these things mention what surface the person stands on. Standing on this wooden floor is quite easy for most people. But get them to stand out on a street corner where they've got angles, uneven pavements, maybe deteriorated pavements, some people might not be able to stand on that." (Interview participant)

Others commented that they felt this was a hidden dimension of how mobility can be limited depending on the type of movement that is being considered.

"I noticed that some people can actually walk on a flat surface, but they can't actually walk up the stairs. Because if you say to someone, if they can actually walk unaided, yes, they can. But they might not be able to actually walk up the stairs." (Focus group participant)

One respondent highlighted that where a person lived affected the kinds of surfaces which they encountered on a day-to-day basis, for example people in rural areas who have to use unpaved surfaces.

"Need to consider that not everybody lives in a place with kerbs and pavements but in rural areas where there are none of these and very uneven surfaces." (Survey respondent)

Time

Several participants noted that the length of time it takes to travel a set distance is as important as the distance itself.

"There's also an element of how long will it take to do these things?" (Interview participant)

"Say I've got to stop, 15 times, in doing that, is there a timescale on the distance that you walk - the 200 metres - as well? Or is it just a case of, well, you can walk 200 metres in an hour so you're fine." (Interview participant)

Others highlighted that they think in terms of time rather than distance when considering journeys e.g. a five or ten minute walk, rather than 200 metres. One participant suggested that travel time should be used in the decision-making process in addition to distances.

"Put an assessed time on it, for walking the distances." (Interview participant)

Respondents were asked to comment on this suggestion as part of the follow-up survey. Responses were mixed, with just over a third of respondents (39 per cent) disagreeing, compared to similar numbers agreeing (34 per cent) and just over a quarter (27 per cent) neither agreeing nor disagreeing.

Table 9. "Put an assessed time on it, for walking the distances." (n=186)

	% of respondents*
Agree	34
Disagree	39
Neither agree nor disagree	27

*Figures may not add to 100 per cent due to rounding.

Balance and confidence

Several participants and survey respondents suggested that the decision-making process should look at how an individual's balance can affect their mobility. Both in terms of trips or falls, and how poor balance can create the need for additional support when moving around or reduce confidence in moving.

"What about using the word balance? Because that's part of my daughter's problem, and I'm sure a lot of disabled people struggle with their balance. If you can't balance at all without holding on to something, you need help moving around and just because your balance is poor and you need help doesn't mean you can't walk at all, you can't make the effort. So, balance for me is part of the issue with this." (Interview participant)

"And there's also the mental thing that goes along with [balance], because if you've had some bad falls then that affects you mentally." (Focus group participant)

Stamina and limits of mobility

A few participants and respondents suggested that stamina needs to be considered during the decision-making process, and that it would also be important to understand the limits of a person's mobility, particularly when fatigue becomes an issue.

"The ability to repeat the task over a day should be assessed. Conditions can fluctuate but also deteriorate rapidly when repeated." (Survey respondent)

"One of the things that it doesn't take into account is stamina and capacity for anything more than 200 meters […] I think it might be worthwhile saying 'How far could you walk, unaided, without being tired or needing help?'" (Interview participant)

As part of the follow-up survey, respondents were asked whether they agreed or disagreed with the suggestion to ask how far a person could walk without being tired or needing help. The majority (66 per cent) agreed, as summarised in Table 10 below. However, almost a fifth (19 per cent) disagreed.

Table 10. The criteria asking: "'How far could you walk, unaided, without being tired or needing help?'" (n=189)

	% of respondents*
Agree	66
Disagree	19
Neither agree nor disagree	15

*Figures may not add to 100 per cent due to rounding.

Effects of medication

A few participants and respondents suggested that decisions should take account of any significant side effects from medication which may affect mobility, particularly where these result in issues not directly caused by an individual's condition.

"By looking at actual effects of medication that the person has described – they don't have to look at the side effects on every single label. But, if the person is describing a significant side effect, don't ignore it." (Interview participant)

A holistic approach to mobility

Some participants stated that asking about the distance that someone can move is a one-dimensional approach to mobility which cannot fully capture their own experiences, and that a more holistic approach is required. A few participants linked together some of the factors outlined above, describing how the intersecting and mutually affecting aspects of their conditions influenced their mobility. For example, where anxiety over moving worsens the consequences of moving.

"It's not, for me, the distances, it's the time and the pain and I get anxious, you know, because you're always going to be somewhere, so you want to be there quickly. But, in my case, as soon as I try to speed up, because I'm very slow anyway, [with my condition], speed makes it worse." (Interview participant)

Everyday situations

Others suggested that a better way to understand an individual's mobility would be to ask about their ability to manage within everyday, real-life situations.

"Not just saying, let's just look purely at what you're physically able to do. Let's look at this in what real world situations you would come up against. If we dumped you in the middle of a supermarket with lots of things around you – which is an everyday situation that a lot of people find themselves in – which one of these descriptors would apply? None of them would apply." (Interview participant)

"I think there should be categories for like, everyday sort of things. Like, can you carry a shopping bag? Obviously if it's a day with my two sticks it's just not possible. Even if it's a one stick day, carrying heavy shopping just isn't a thing for me. […] So I think there should be, everyday tasks, and not just, how far can you walk. 'Cos a person could be able to walk like 10, 20 metres, but what's the point of walking 10, 20 metres if you can't do anything except walk those metres or whatever. What's the point of walking if you can't do anything else? You can't do your shopping, can't you know, take a dog for a walk or you can't complete an everyday task, doing the gardening, whatever. There should be more scope and variance, not just, can you walk this far." (Interview participant)

As part of the follow-up survey, respondents were asked if they agreed or disagreed with the suggestion to include categories for everyday actions within the criteria. The majority of respondents (70 per cent) agreed with this suggestion.

Table 11. The criteria including: "Categories for like, everyday sort of things. Like, can you carry a shopping bag? […] more scope and variance [to what mobility means], not just can you walk this far." (n=188)

	% of respondents*
Agree	70
Disagree	14
Neither agree nor disagree	16

*Figures may not add to 100 per cent due to rounding.

Describing mobility

Some participants suggested that the complexity and variety of factors that influence mobility meant an open-text format - where people could describe how their condition or conditions affect their mobility - would be more suitable than choosing from different criteria.

"Would it not be better just to get a description from somebody on how they get about and the difficulties that they have, and then make a kind of judgement? […] I think there are so many variations on disability that I don't think you can put it down to a points system where you're only deciding to judge on a person's ability to walk." (Interview participant)

"Describing what happens when you've been walking for a period of time. Can you walk on a level? Can you walk on a slope? Can you walk on an uneven ground? […] Being able to describe it. It's not a yes or no question, it's a situation that has a context." (Interview participant)

Survey respondents were asked if they agreed or disagreed with the suggestion to have a space available for describing what happens after they have been walking for a period of time. The majority of respondents agreed (75 per cent), with less than one in ten (9 per cent) disagreeing.

Table 12. "[Have a space to describe] what happens when you've been walking for a period of time. […] Being able to describe [the context around walking]." (n=187)

	% of respondents*
Agree	75
Disagree	9
Neither agree nor disagree	16

*Figures may not add to 100 per cent due to rounding.

One respondent noted that even if additional space was provided for someone to describe how their conditions affect them, this may not be an accessible method for everyone. They also noted that the length of time someone has been living with a condition can affect how well they are able to self-assess and describe its effects on them.

"Questions fail on 2 things: 1) a person's ability to self-describe in clear prose is subjective. Few have that self-awareness or writing skill. 2) if someone spent 20 years getting incrementally worse, describing their reality to a fit person is impossible." (Survey respondent)

Individual symptoms or effects

For some survey respondents, it was particularly important that an individuals' mobility needs be considered on the basis of their specific conditions and individual symptoms. Comments highlighted that respondents felt no two people experienced conditions in the same way, and that for those whose conditions have been deteriorating over a long period of time, it may be especially difficult to self-evaluate in the way required by the current criteria.

"It depends on each person, everyone is different." (Survey respondent)

"With some life-long diagnosis where there is no cure only therapy, it is virtually impossible to give an accurate gauge, it really is time to stop persecuting these people with lengths, times, and assumptions." (Survey respondent)

A few participants and respondents commented that a more holistic approach is required for people with visual impairments. They highlighted that these individuals may have good mobility and be able to walk the distances used in the descriptors, but face other challenges which limit moving around, for example, blurred vision.

"I would prefer that mobility be considered as a whole person activity, with personal risk versus benefit being taken into consideration, for example walking with blurred or double vision." (Survey respondent)

Using aids

Some participants and survey respondents highlighted that they were unsure how the use of a mobility aid related to the criteria and how they should self-assess based on their use of aids, particularly where this results in very different levels of mobility when compared to moving without an aid.

"Aided vs Unaided is an issue. Not everyone has an aid, and just because you do, it doesn't mean you can walk. What is an aid? A crutch/person/other? Each has a different impact on ability and independence. What about the why? Pain, muscle control?" (Survey respondent)

"If youse could break it down, dumb it down, so's that somebody like myself would be able to understand the difference between walking aided with a crutch down the stairs to your living room, to a total of maybe a couple of feet, to having to use a wheelchair when you're outside and not walking at all. If the wheelchair is down as one of the aids in your descriptors I think you need to explain, dumb it down, so that we understand it more." (Interview participant)

A few participants commented that if an individual is capable of moving when using an aid, but not without, this should not result in a lower score.^[3] These participants expressed a preference for mobility to be considered only on the basis of unaided movement.

"It is very easy for someone to use a Zimmer frame, for example, or a walker which means they can move more than 1 metre. But, take the walker away so they're unaided and immediately they can't do that, they're into [descriptor] F. So, you when you say aided or unaided, a lot of people who use aids can do better with aids than without, so should it be the case that the person with an aid should be penalised in that respect? […] It's the aspect of, an aid can enable you to do something, but it should be a case of you should be assessed on the ability without the use of supports." (Interview participant)

Relatedly, one focus group participant pointed out that movement with an aid is conditional and depends on having access to that aid, meaning that aided and unaided movement cannot be considered equally.

"If they are aided or unaided, they're not necessarily the same. Some people might be able to do it aided, but they might not have aid." (Focus group participant)

Other suggestions

There were various other suggestions made by participants and survey respondents, which are covered in brief below.

Increased involvement of health professionals

Some participants and respondents suggested that there should be a greater involvement from health professionals in the decision-making process. Suggestions included granting health professionals the authority to trigger a review of a person's mobility needs, and including in the decision-making process any recommendations or observations made by them.

"A review should be triggered if your health professional thinks it's required. […] That's probably something where your health professional can say, 'Right, I think you need to trigger this with the social security because your mobility has changed.' I think it's something that you should be able to ask for, rather than be assessed by." (Interview participant)

"Assessments should include reports from medical personnel regarding clients' capabilities." (Survey respondent)

Face-to-face meetings and consultations

An important difference between ADP decision-making processes and those used by the DWP for PIP, are that there are no UK Government-style assessments. For ADP, people are only invited to a consultation on occasions when Social Security Scotland require more information so that they can make a decision. In addition, there aren't any degrading functional examinations, such as asking a person to "touch their toes". However, previous experiences of DWP assessments led to participants and respondents holding mixed views on whether consultations should take place in person or through another means.

A few participants stated that they would prefer to have face-to-face meetings when a consultation was required as part of the decision-making process with Social Security Scotland. One participant commented that they felt a previous phone assessment by DWP had resulted in a negative outcome as they were not able to communicate well with the person conducting the assessment, combined with a lack of knowledge about their conditions.

"I think [the reason that the outcome was negative for me] partly is the assessment was done over the phone, by somebody who didn't know anything about the health conditions that I have." (Interview participant)

However, others described previous face-to-face assessments with DWP as stressful and demeaning, leading to a preference for having face-to-face consultations removed from Social Security Scotland where possible.

"It's just face-to-face, you know, it's nerve-wracking. Getting watched, and also, face-to-face you're getting, 'Oh, can you do exercises?" you know, lift your leg – that's demeaning." (Interview participant)

Accounting for temporary conditions or mobility issues

One focus group participant described a situation where a neighbour had been refused support for a serious mobility issue by DWP because the condition had been viewed as temporary. They suggested that there should be some support available for short to mid-term conditions which seriously affect a person's mobility.

"That was a really bad situation for her for at least six months, because she couldn't move – she was laid on her front for three months. Then she had to learn how to walk, how to move and everything but they still wouldn't agree that she was actually disabled. […] [The DWP] were thinking that within three or five months she will be fine to do her activities, but actually she was restrained from doing so many things because of her spinal cord […] she couldn't actually leave home sometimes." (Focus group participant)

Preferred areas of change

As part of the follow-up survey, respondents were asked to consider some areas for change within the mobility criteria. These were broad suggestions rather than specific changes, which respondents were asked to rank by preference from most to least important. The three suggestions were:

1) An increased focus on everyday tasks and activities which involve moving around.

2) Reconsidering the distances used.

3) Taking a more holistic look at a person's mobility needs, taking into account personal, environmental and health circumstances.

The most popular suggested area for change was number 3 – taking a more holistic look at a person's mobility needs – which almost two-thirds (64 per cent) of respondents chose as their first preference. The least preferred option was number 2 – reconsidering the distances used – which was ranked as least important by almost half (47 per cent) of respondents. Table 13 below shows the number and percentage of respondents for each option who ranked it as the most important area for change.

Table 13. Most preferred area for change within moving around criteria (n=186)

Option (from most to least popular)	% of respondents*
3) A more holistic look at a person's mobility needs, taking into account personal, environmental and health circumstances	64
1) Increased focus on everyday tasks and activities which involve moving around	23
2) Reconsider the distances used.	13

*Figures may not add to 100 per cent due to rounding.

Additional mobility costs

Participants were asked if there were any additional costs which they incurred as a result of having limited mobility.

Increased transport costs

Some participants highlighted the increased transport costs that they have, particularly where public transport is limited, such as in rural areas, or where there are limited options for accessible transport.

"I personally live in a small village, you can't get a bus. So, if you're not physically able, you have to have a car, you have to have your own transport." (Interview participant)

"The nearest station to the venue I go to is totally inaccessible. It's only got stairs. So, I've got to get a ticket to the next station, which is accessible." (Focus group participant)

Additional support at home

A few participants commented that there might be additional costs where extra help is needed with tasks around the home such as cleaning.

"There might have to be a home carer, or somebody to do your housework." (Interview participant)

Increased outlay on other items

One participant provided a detailed description of the additional costs that their conditions caused through immobility, which left them largely bed-bound. This meant that there was a need for additional bedding and bed clothes, and also increased energy costs through the need to do more washing and drying.

"I've got multiple [skin conditions], cause I'm in bed all the time my wife constantly has to buy sheets and pillows for me 'cause of the blood, basically me scratching during the day, during the night. Obviously lying in the bedsheets they get dirty as well […] so, there's a lot of costs that you don't think about when you've got a disability, that you don't realise until you're actually disabled, the extra things you need […] definitely for me, with my condition, new t-shirts, new [pyjamas], new bedsheets, and that's on a regular basis and then on the other end of it you've got the washing [and if you can't dry it outside] you've maybe got to put the heating on to dry your clothes and your bedsheets and all that to try and get them dry for the night. So, it kicks in, things like the electricity and the gas and that people may not think about but that's an added bill you've got that many people maybe don't think about when you've got a disability." (Interview participant)