PIP Appeal advice please

Hi
I’m writing on behalf of my sister who is a disabled single mother who suffers with depression and anxiety and complex health issues arising from so many things : fibromyalgia, osteo arthritis, adult rickets, abnormal lower spine narrowing + previous back injury, complex gastro issues, uterine issues, and so much more; she suffers with depression. She really struggles to cope and depends 100% on family to visit her daily and help her. Adult social services are becoming involved to provide some home adaptations. We’re somewhat confused because her PIP for Daily living activities has been reduced recently even though her mobility allowance has been increased, and even though she (we) marked on the review form that there was either no change in the daily living challenges which she faces or that they are harder for her than before. The overall result is a reduction in her PIP. We did ask for a review and got an answer which indicates no change has been made and that she can appeal if she wants. She finds it all very stressful and we don’t know what to do. We are worried in case they reduce her PIP further on appeal even though it does seem wrong.
In Feb 2015 she got a letter saying:
I’ve decided you are entitled to the daily living component at enhanced rate of £81.30 a week until 23 July 2017/ not entitled to either rate of mobility component.
She scored:
Preparing food 2
Taking nutrition 4
Managing therapy 1
Washing and bathing 2
Managing toilet needs 2
Dressing and undressing 2
Reading and understanding 0
Engaging face to face 2
Making budgeting decisions 2
Total 17
Mobility : 0

In Nov 16 following re-assessment she got a letter saying:
I can award you the standard rate of £55.10 a week to help with daily living needs
I can award you the standard rate of £21.80 a week to help with mobility needs
Daily living scores
Preparing food 2
Eating and drinking 2
Managing treatments 0
Washing and bathing 2
Managing toilet needs 2
Dressing 2
Communicating 0
Reading 0
Mixing with other people 0
Making budgeting decisions 0
Total : 10

Mobility
Planning a journey 0
Moving around 10

The fact is she is so bad she can’t even plan a journey to anywhere unfamiliar and would have to take a taxi or depend on family to get her somewhere.
Also she is terrible with all of the daily living activities – so bad she doesn’t know what’s going on half the time and forgets things, gets confused, and just can’t communicate properly because she is so stressed, anxious, and depressed and in pain all the time. She turned up to hospital in recent months not understanding if she was about to have an operation or not.
However the Nov 16 decision letter says
“I looked at the information you provided, the further health professional consultation ( an OT report) and changed the descriptors previously chosen as your circumstances changed. I increased your mobility component from the date you applied; as your needs are likely to continue I awarded you Pip for a longer time.
However, on grounds of medical evidence received I have reduced your award of daily living component….I made my decision using info about your health condition or disability including details of any treatment, medication, test results and symptoms. This info is the best we have available and enough to decide how much help you need.
As your needs vary my decision is based on the help you need most days.
You said you have difficulties manging therapy or monitoring a health condition, communicating verbally, reading and understanding signs, symbols and words, engaging with other people face to face and making budgeting decisions. I decided you can either manage medication or therapy or monitor your health condition unaided, or you do not need to express and understand verbal information unaided, read and understand basic and complex information either unaided or using glasses or contact lenses, engage with other people unaided and make complex budgeting decisions unaided, you said you have difficulties preparing food, taking nutrition, washing and bathing, managing toilet needs or incontinence and dressing and undressing. I decided you needed an aid to prepare or cook a simple meal, eat and drink, wash and bathe, manage your toilet needs or incontinence, and dress and undress.
You said you have difficulty planning a following journey. I decided you can plan and follow the route of a journey unaided. You said you have difficulty moving around. I decided you can stand and then move using an aid or appliance more than 20 metres but no more than 50 metres.
The evidence suggests you have normal cognition, insight, memory and speech. You reported that you are able to use a mobile phone. You were observed to read through identification documents at the reception area.You coped well at your consultation. You made sufficient eye contact and built adequate rapport with the health care professional. You have lower limb and back restrictions. You were observed tio walk at a slow pace.
This is consistent with your medical history, informal observations at your face to face consultation, how you engaged with the assessor, the available evidence, your mental state examination results and your musculoskeletal examination results.
I cannot consider any help you need not covered by the activities for daily living and mobility, including being driven in a car, food shopping and managing stairs. I awarded you Pip for a set time as your needs may change. “

The frustrating thing is that she was referred for therapy by her gp and failed to engage as she felt it would achieve nothing because she is in so much pain and also so distressed and lacking in communication skills she could not even communicate with the therapist and fill in pain diary records. Her child is a child in need and children social services are involved. She can’t help him with homework or anything complex.
On the PIP renewal form and also in the request for review all the points were made about how forgetful she is and how dependant she is on everyone in her family to help her. She has an ADHD child and his school have asked for an EHC. There are regular meetings concerning the child. She doesn’t understand much. There is a lot of complex info to deal with and we have to help her deal with it all or she is lost.
In Dec 16 following the request for review she got a letter deciding no change would be made. This is the reasoning:
I made my decision using info about your health condition or disability including details of any treatment, medication, test results and symptoms. This info is the best we have available and enough to decide how much help you need. I looked at all the info and the areas you disagree with and find the descriptors chosen are correct. You said you have difficulties preparing food, taking nutrition, washing and bathing, managing toilet needs or incontinence, and dressing and undressing. You were observed to be well kempt and of average build. However, you have been given a diet plan and your physical examination indicates you have restriction with your back and lower limbs. However, you have normal movement and power in your upper limbs. Therefore, it is reasonable to suggest you would need aids to carry out these activities safely, reliably and repeatedly for the majority of days.

You said you have difficulty managing therapy or monitoring a health condition, communicating verbally, reading and understanding signs and symbols and words, engaging face to face and making budgeting decisions. At your assessment you reported you use a mobile phone and can read. You were observed to interact with reception staff. You engaged well with the assessor displaying good eye contact and rapport. Your speech was normal in pace and volume and content. You did not require any prompting and you demonstrated you have good cognition, memory, insight and concentration. Therefore, it is reasonable to suggest you can carry out these activities safely, reliably, and repeatedly for the majority of days.
You said you have difficulty planning and following journeys. To follow the route is the visual, cognitive and intellectual ability to reliably navigate a route and the accompanying person must be actively navigating not just present for example for reassurance.
At your assessment you engaged well with the assessor, you showed no signs of anxiety and did not require any prompting. You demonstrated you have good cognition, memory and concentration. Therefore, it is reasonable to suggest you can plan and follow the route of a journey safely, reliably and repeatedly for the majority of days. This is consistent with your medical history, informal observations at your face to face consultation, how you engaged with the assessor, the available evidence, your mental state examination and your musculoskeletal examination results. I cannot consider any help you need not covered by the activities for daily living and mobility including child care and stairs.”
Is she at risk of losing further points if she appeals? The decision appears to be wrong in every respect and we know first-hand how bad she is – she gets lost on her way to her own GP surgery when she is walking and she’s lived there for ten years! She can’t deal with paper work. She has had tantrums at her GP surgery due to depression and pain when she isn’t seen ( they wont do a report confirming this) and she is so distressed and depressed. There is so much going on its impossible to explain everything but day to day it is her family who are picking up the threads of her life and trying hard to help her make it work.