Child Disability Payment decision making guide
Common definitions
Period throughout which
The “period throughout which” (CDP regs, reg. 11(1)) refers to the period when a person due to their physical or mental disability meets any of any of the following care component criteria:
- they require attention from another person for a significant portion of the day in connection with their bodily functions
- they are aged 16 or older and are unable to prepare a cooked main meal for themselves if they have the ingredients
- they require throughout the day frequent attention in connection with their bodily functions, or continual supervision from another person to avoid substantial danger to themselves or others
- they require prolonged or repeated attention throughout the night1 from another person in
connection with their bodily functions. Or, if another person requires to be awake for a prolonged period of time, or at frequent intervals to watch over them to avoid substantial danger to themselves, or others.
In addition to meeting the care component criteria, the individual must have met and are deemed likely to meet this criteria during the relevant time period. This is known as the backwards and forwards test (CDP regs, reg. 11(3))
The case manager should both:
- take a broad view by looking at the whole period
- determine if the individual can fairly be described as satisfying the entitlement criteria.
This does not mean that the individual requires care:
- on any particular day and/or night
- on a specific number of days and/or nights each week
- more than 50% of the time.
Taking the whole period into account
- means considering how the individual meets the entitlement criteria over the whole period
- involves making an exercise of judgement, taking into account all of the supporting information
- does not mean just calculating how often the individual requires care to determine entitlement.
Emma is 15 and has Crohn’s Disease. It was diagnosed six months ago after experiencing diarrhoea, incontinence, bloated abdomen and blood in her stool. Emma’s mother has just completed the application for CDP. Emma has had care needs for more than 13 weeks preceding her application being submitted.
Emma has regular toilet accidents both during the day and the night when her symptoms become more acute.
She wears protective pads at school as she is worried about incontinence during acute episodes. She manages this well on her own.
Her toilet accidents at night happen approximately four times per week. When this happens, her mother:
- helps her with cleaning herself
- changes the bed clothes.
This takes about an hour every time.
Emma also adheres to a special liquid diet from the dietitian during acute episodes. Her mum prepares the liquid diet and also ensures she takes all of her medication. When Emma does not have acute symptoms, she only needs her mother to make sure she takes her medication.
Her acute episodes are irregular and can vary in length. Over the last six months, Emma had acute symptoms:
- twice for about a month
- once for about ten days
- a few bad days in between these episodes.
The remission time when she felt better in between these periods varied from five weeks to five days.
The case manager is satisfied that Emma:
- has met the entitlement criteria over the 13 weeks immediately preceding the date of entitlement
- is likely to continue to meet this criteria for 26 weeks from the date of entitlement.
Taking into consideration Emma’s care needs during the whole period the case manager awards her the middle rate of the care component.
So severely physically or mentally disabled
To qualify for the care component, the individual must be “so severely disabled physically or mentally” that they need attention or supervision from another person (CDP regs, reg. 11(1)(a),(c),(d)).
There is also a separate test for an individual who is 16 years old or older and who does not require attention or supervision from another person. The individual can meet the care component criteria if they are unable to prepare a cooked main meal for themselves if they have the ingredients (CDP regs, reg. 11(1)(b)) due to their
physical or mental disability. This is not a test of cooking ability. Instead, it looks at whether an individual can plan a complex activity and complete that activity safely.
Supporting information from healthcare professionals involved in the individual’s care or treatment:
- is important and useful
- may not always be readily available.
Case managers usually request one piece of supporting information from a professional. However, the lack of a diagnosis does not prevent an individual from being awarded CDP.
Please see the Gathering Supporting Information chapter for more information Case managers should consider both if:
- the individual has a physical or mental disability
- the impact of that disability means that the individual meets the eligibility criteria for CDP.
References to “severely” do not refer to the severity of the individual’s condition. They refer to the severity of the consequences of the individual’s disability. This means the severity of the needs that result from having that disability.
Needs substantially more than would be expected
This section applies only to individuals under age 16 (CDP regs, reg. 11(4)).
The individual’s need for attention or supervision either:
- must be substantially more than would be expected for a person of the same age (CDP regs, reg. 11(2))
- would normally be associated with a person of a younger age, without a health condition or
disability but not with a person of the individual’s age (CDP regs, reg. 11(2)).
To determine whether an individual is in need of more attention or supervision than would be expected
for their age please visit NHS Ages and Stages website.
Reasonably required
The attention or supervision that an individual needs must be reasonably required (CDP regs, reg. 11(8))
This means considering all the circumstances of an individual case, including:
- supporting information
- the nature of the individual’s health condition and how it affects their bodily functions
- how often attention or supervision is required and for how long
- whether there is an aid or appliance that the individual could use to manage a bodily function independently.
Reasonably required does not mean medically required. Medical attention like visits from a district nurse, should be considered as part of the individual’s wider need for attention.
Entitlement to the care component is based on the attention or supervision that the individual reasonably requires. It is not based on the attention or supervision the individual actually receives.
Nikolai is six years old and was diagnosed with Stage 2A cancer four months ago. He started undergoing chemotherapy shortly after the diagnosis.
Due to his treatment, Nikolai is often sick shortly after eating and generally feels very tired.
His parents:
- have to change Nikolai and clean up whenever he has been sick
- help him with eating and dressing as he is often too exhausted to do this himself.
His parents are also very scared that something might happen to Nikolai at night. They get up three times every night to check on him to prevent him from choking in his sleep in case he vomits. They do this even though Nikolai has never vomited at night.
Nikolai is entitled to the middle rate of the care component as he needs help with his bodily functions during the day. He is not entitled to the higher rate of the care component because:
- his parents checking on him at night is not reasonably required
- he does not need support or attention at night.
Aids and Appliances
The need for attention or supervision may be reduced or removed by the use of an aid or appliance.
Aids or appliances may be available to reduce the impact of an individual’s disability. Whether something is considered an aid or appliance may depend on:
- if it is an object or device and;
- if it improves, provides or replaces the individual's impaired physical or mental function
(KR v Secretary of State for Work and Pensions [2015] UKUT 0547 (AAC)(link is external))
For example:
- adapted cutlery to help cut up food and take nutrition
- raised toilet set and grab rails to assist with getting on and off the toilet
- hearing aids to assist with hearing and communicating
- enlarged font or text to speech software to assist with reading
- bath seat to ensure the individual's safety while bathing
This list is not exhaustive.
Medication
Although medication may improve an individual's impaired bodily function in some circumstances, it is not a device and therefore not an aid.
For example, an individual may be prescribed medication to control their asthma and improve the bodily function of breathing but the medication itself is not a device and therefore not an aid.
The need for attention or supervision may still reasonably be required to ensure that medication is taken safely and at the appropriate times.
An aid or appliance must, in itself, improve the individual's impaired bodily function. Devices such as inhalers, inhaler spacers, nebulisers and EpiPens are not aids or appliances because, while they can deliver medication, they themselves do not replace the individual's impaired bodily function.
If an individual requires a device to deliver medication, the need for attention or supervision may still reasonably be required to ensue that is is used correctly.
Abby is 8 years old and has asthma. When she experience's exacerbations of her condition, she becomes breathless and requires a reliever inhaler fitted with a spacer. Abby requires someone to set up her inhaler with the spacer and to dispense the medication. Without this attention Abby would not be able to use her inhaler effectively.
The case manager must decide whether it is both reasonable and practicable for the individual to obtain and use them.
Tor is 13 years old and has cerebral palsy. She is unable to stand up from a seated position independently. To help her get on and off the toilet independently, her occupational therapist has provided her with a raised toilet frame and seat. Tor’s mum has noticed both that:
- Tor’s upper body strength has reduced
- she has difficulty pushing herself up from the sitting on the frame and seat.
The case manager decides that it is a reasonable aid to use but that it is not practicable for Tor to use it.
Lee is 15 years old and has had a stroke. He has weakness in his left arm and leg. This means he has had great difficulty getting out of bed independently. Lee now has an adjustable bed and has been fitted with a leg splint and an arm splint.
The splints:
- help him to balance better
- strengthen the muscles in the affected area
- improve his mobility.
Lee can now get out of bed independently once his splints are on. His father helps him to put these on.
The case manager decides that
- it is reasonable and practicable for Lee to use this appliance
- Lee does not need help with getting in and out of bed.
Case managers should consider:
- the consequences of any suggested aid or appliance
- if it is safe for the individual to use a particular aid or appliance
- asking for advice from a specialist practitioner if it is not clear that an item is reasonably appropriate.
It is not necessary for an occupational therapist or other healthcare professional to recommend an aid or appliance.
Case managers may also seek supporting information about the individual’s home circumstances from their carer, for example. This is because the layout of the individual’s home may not be suitable or practical for some aids.
The individual must also have somewhere private to use an aid such as a commode. If there is no suitable private place for the individual to use an aid, then it is unreasonable to suggest they use it.
Day and Night
Whether the individual requires attention or supervision by day or by night should be considered in relation to the ordinary domestic routine of the household where they live (CDP regs, reg. 11(6)(a))
There may be considerable variation between households. Case managers should take a broad view of when the household as a whole closes down for the night.
For CDP, this generally considers when the individual’s parents or carers go to bed in determining whether needs come within the day or the night criterion. This is rather than when the child or young person goes to bed. The individual’s parent or appointee may be describe this information on the application form. If there is any doubt about the household routine, case managers should consider asking the parent or appointee for this information.
Jennifer is 9 years old and lives with Type 1 Diabetes. This leads to incidents of incontinence at night.
Jennifer’s parents have established the following bedtime routine to help manage this:
- 8pm: Jennifer’s bedtime
- 10pm: one of the parents takes Jennifer to use the toilet
- 11pm: parent’s bedtime.
The attention provided at 10pm is relevant to the day, rather than the night criterion.
There are cases where the individual’s parents or carers alter their bedtime routine to accommodate their child’s needs before they themselves go to bed. This attention is relevant to the night criterion. Case managers might have to clarify with the parents or carers what their bedtime routine was before their child developed their needs.
Sinem is 10 years old and suffers from Attention Deficit Hyperactivity Disorder (ADHD). This makes it difficult for her to fall asleep. Once Sinem is in bed, she is restless and can be anxious. Her parents check on her regularly to soothe her if needed. Hearing them in the living room and kitchen helps Sinem to calmherself. It normally takes her around three hours to fall into a deep and prolonged sleep. In order to manage Sinem’s needs, her parents have pushed back their regular bedtime. Before Sinem started to have issues falling asleep, they normally went to bed around 10pm. This is because they have to get up at5am to care for their daughter and get ready for work.
However, they now follow this bedtime routine:
- 9pm: Sinem’s bedtime
- Midnight: Sinem’s parents go to bed, as Sinem will have fallen asleep by then.
The attention provided between 10pm and midnight is relevant to the night, rather than the day criterion.
Isabella is 8 years old, and has been diagnosed with Autism Spectrum Disorder. Isabella has no verbal communication and frequently bangs her head on hard surfaces when she becomes distressed. Isabella needs continual supervision during the day to stop her from injuring herself. Isabella wakes frequently during the night and can become distressed. This results in Isabella banging her head on any surface she is able to access until she falls back asleep. Isabella will not tolerate being held, especially when upset as this causes her to become more distressed. To keep her safe, Isabella’s parents need to stay in the room with her when awake and redirect her or block her from accessing surfaces that she can hurt herself on. This happens once or twice a night, 4 to 5 nights per week, and takes her parents about an hour each time to settle her.
The Case Manager decides that Isabella is entitled to the highest rate care component. This is because Isabella needs continual supervision during the day, and another person to be awake for a prolonged period or at frequent intervals at night, to avoid substantial danger to herself.