Child Disability Payment decision making guide
Confirmation from a professional
Every individual who applies for Child Disability Payment is asked to provide confirmation from a professional where possible.
The confirmation from a professional should broadly confirm the individual’s conditions, disabilities or needs. It can only come from professionals.
For example, the confirmation may provide details on:
- a diagnosis, where an individual has been diagnosed
- a treatment being received, such as medication or physiotherapy
- steps taken to find out about the individual’s condition and make a diagnosis
- aids and equipment that an individual uses to manage daily life
- an individual’s needs where they do not have a diagnosis
The individual can provide a confirmation from a professional or you can gather it from a professional on their behalf.
The role of a confirmation from a professional
The confirmation from a professional only needs to broadly confirm the individual’s conditions, disabilities or needs.
It is not necessary for this piece of supporting information to confirm:
- every detail the individual has outlined in their form
- every condition or disability they might have
- the severity of the disability or condition, the level of needs or how it impacts them
- conditions that account for both Child Disability Payment components, if the individual’s needs cover both components
- the individual’s formal diagnosis
An individual may apply with multiple conditions. It is not a requirement to have a confirmation for each stated condition. However, the confirmed condition must account for more than a minor portion of the needs relevant to the Child Disability Payment eligibility criteria.
Where you have a confirmation for one or some of the conditions but not all, you should not assume that the individual has been dishonest about the unconfirmed conditions.
You should:
- continue to take a trust based approach in what the individual has told us about their conditions on their application form
- refer to the guidance on this page regarding when an additional confirmation may be needed
The confirmation might also provide additional details on the impact the condition or disability has on the individual’s day-to-day life. You should not expect this. This level of detail would be expected from additional supporting information.
If the confirmation from a professional that is available contains additional details, you must not disregard these but should consider them separately when establishing the individual’s entitlement and needs.
In some circumstances, an application may be progressed without a confirmation from a professional. You need to have established good cause in order to negate the need for a confirmation from a professional.
You should refer to the guidance in this chapter for information on what to do where an application lacks the confirmation from a professional, including instances where you cannot establish good cause.
Good cause is the term for a reasonable explanation as to why confirmation from a professional is not available or is delayed on an application.
Confirmation from a professional and gaps and inconsistencies
In their confirmation, professionals may provide information that is partially inconsistent with what the individual has told us on their application form. These inconsistencies can relate to:
- the broad confirmation of the conditions, disability or needs
- the severity of the needs the individual has told us about
Inconsistencies relating to the confirmation of conditions, disability or needs
The confirmation from a professional might, for example:
- not mention one or multiple conditions the individual has told us about
- explicitly state that the individual does not have the condition they have told us about
The confirmation does not mention all conditions, disabilities or needs
Confirmation from a professional:
- does not have to confirm all conditions, disabilities and needs the individual has told us about. However, sometimes this can be an inconsistency that is relevant and needs exploring
- should confirm a condition that is related to the individual’s needs in more than a minor way in order to be acceptable. These needs must be relevant to the Child Disability Payment eligibility criteria
You will have to consider these two points whenever an individual applies with multiple conditions and their confirmation from a professional provided or gathered to support this application does not confirm every condition or all of their needs.
Establishing whether an inconsistency is relevant
You should use your judgment and knowledge about the case at hand when establishing whether an inconsistency is relevant and needs exploring. If you are unsure, you should request a case discussion.
You should not automatically assume that the individual is dishonest and does not have that stated condition or need – it might be reasonable to assume that the professional was unaware of all of the individual’s conditions.
For example, relevant considerations might be :
- whether the confirmation from a professional is a pre-exiting document, such as a referral letter. Here, it would be reasonable to expect that it will not mention all of the client’s conditions. In order to find out whether an additional confirmation from a professional might still be required, read the next section
- for example, a teacher providing confirmation might only be aware of the individual’s conditions that impact on their ability to learn at school. It would be reasonable to assume that they would not be aware of conditions that impact on other areas of the individual’s life, such as night time needs. In order to find out whether an additional confirmation from a professional might still be required, read the next section
- whether it would be reasonable to expect that the confirmation from a professional mentions all conditions the individual has detailed in their application form. For example, if one of the individual’s conditions is a known comorbidity of the other condition the individual has told us about and the professional treating the individual only confirms one of the conditions, this would be a relevant inconsistency. This inconsistency would need to be explored, irrespective of whether the document confirms significant portion of the needs mentions in the application form
This list is not exhaustive.
If you decide that an inconsistency is relevant and needs to be explored, you should follow the existing guidance on gaps and inconsistencies.
Independent of whether or not the inconsistency is relevant and needs to be explored, you also need to consider if an additional confirmation from a professional may be required.
When an additional confirmation from a professional may be required
Confirmation from a professional does not always have to cover the individual’s main condition. For example, where an individual has two conditions and provides confirmation on the condition that causes a significant number, but not most, of their needs, you should accept this.
However, where both
- the confirmed condition only is a very minor contributor to the individual’s overall needs, and
- those needs are caused by a much more significant condition,
it would be reasonable for you to expect the individual to provide confirmation of that major condition
If the individual’s confirmation from a professional does not cover the major condition, you should request an additional confirmation from a professional.
There is no established ‘threshold’ or ‘percentage’ of needs the confirmed condition should account for.
Establishing when
- an existing confirmation from a professional is not relevant and
- another confirmation from a professional is needed
will differ from application to application. You should use your judgment to make this decision. If you struggle to understand whether an existing confirmation from a professional is acceptable, request a case discussion.
If you can establish that the confirmed condition is more likely than not to cause a significant portion of the individual’s needs relevant to CDP, you would not need an additional confirmation from a professional.
When considering whether an additional confirmation from a professional is needed, it does not matter whether the existing confirmation covers needs for one or both components, if the individual has both care and mobility needs. It is about the significance of the condition in relation to the individual’s needs that are relevant to the CDP eligibility criteria in total, rather than about having one confirmation per CDP component.
To establish whether you’ll need additional confirmation from a professional, you should:
- consider whether what condition/s or need/s have been confirmed can reasonably be expected to cause any needs relevant to the application
- not apply a fixed ‘threshold’ for the level of needs a confirmed condition should relate to
- use the balance of probabilities in your thinking to consider whether it is more likely than not that the confirmed condition would result in needs relevant to the CDP eligibility criteria
- consider involving a health and social care practitioner to understand the needs associated with a given disability or condition
You should ensure that any decision you make takes into account all conditions more likely than not to cause needs relevant to the application. You should not make decisions that only consider the needs of the confirmed condition.
If you conclude that the confirmed condition/s or need/s are either
- not relevant to the CDP eligibility criteria,
- contributing to the individual’s relevant needs in only a minor way,
you should request another confirmation from a professional which does relate to the individual’s relevant needs in this instance. When requesting this additional confirmation from a professional you should take all the steps outlined in this chapter to support the individual in providing confirmation.
If the additional confirmation from a professional is not available, you should consider whether good cause can be established.
Nikita is 14 and is diagnosed with severe eczema and lupus, her mother submits an application for CDP on her behalf. The application details the ways the conditions impact Nikita’s daily life. Her Mother explains that the eczema:
- stopped responding to treatment within the past year
- is causing topical steroid withdrawal as it is not responding to the steroids she was previously prescribed
- is causing extreme symptoms including severe dry and itchy skin that is prone to cracking and occasionally bleeding
- has severely impacted her mental health as she does not like to leave the house, sometimes even for school, due to the appearance of her skin and how uncomfortable activity makes her
- is causing symptoms that have means she needs more support from her family. Due to the cracking of her skin, it can be painful to carry out activities such as washing and dressing herself
The application also details how Nikita's lupus impacts her life. It explains that her lupus:
- is stable but she still experiences moderate symptoms
- causes symptoms including tiredness and fatigue which leave her feeling very exhausted after carrying out daily tasks such as attending school or college
- causes joint pain in her hands and feet in the morning which can impact her ability to get ready. If it is particularly bad she can require help from her family to get washed and dressed
Alongside her application, Nikita's mother provides an outpatient summary from a recent visit to a dermatologist as her confirmation from a professional.
The summary:
- is dated from a few months prior to Nikita’s application
- shows that Nikita is receiving clinical input for her eczema
- details that her doctors are considering treatment options but are concerned that her eczema has not yet responded to other treatment
- reports that Nikita’s eczema at the appointment was severely inflamed and her skin was very dry and cracked. Her doctor also noted that Nikita’s mobility was impacted by her eczema as she moved at a much more considered and slower pace due to the pain and itchiness
The case manager is satisfied that the outpatients summary broadly confirms what Nikita has told Social Security Scotland about her eczema.
However, Nikita's mother has not provided a confirmation from a professional for Nikita's lupus, which her application also explains impacts her daily life.
The case manager considers whether they need an additional confirmation for Nikita’s lupus. They know that just because they do not have a confirmation for her lupus, they should not assume that Nikita's mother is being dishonest about the lupus.
They know that Nikita:
- has severe eczema that does impact her life and create needs relevant to the application i.e. needs relating to washing and dressing
- Nikita’s condition has been confirmed by a professional
- Nikita’s confirmation provides additional detail about her condition, including that she receiving treatment for the eczema but her clinicians are uncertain if this will improve her condition
Using the information:
- Nikita provided in her application form
- contained in the outpatients summary from her Dermatologist
The case manager concludes that it is more likely than not that Nikita’s eczema does cause a significant proportion of her needs that are relevant to the CDP eligibility criteria.
Therefore, they decide that they do not need to gather an additional confirmation from a professional to confirm Nikita’s lupus. This is because they take a trust based approach and they already have a confirmation broadly confirming a number of Nikita’s needs that are relevant to the CDP eligibility criteria.
The case manager can now continue in their decision-making process to establish entitlement and needs.
Any decision they make in regards to Nikita’s entitlement should take into account the needs relating to both her eczema and her lupus.
The case manager should not only consider Nikita’s needs relating to the confirmed condition, but should also establish and consider Nikita’s needs relating to any other conditions on her application form.
The confirmation explicitly denies what the individual has told us about their conditions, disability or needs
In some instances, the professional you reached out to for confirmation of the individual’s conditions, disability or needs might directly deny that the individual has a certain condition, disability or need. This is different from instances where the confirmation from a professional simply does not mention one or multiple conditions or needs the individual told us about.
Taking a trust based approach, you should establish whether this inconsistency needs to be explored or whether there is a reasonable explanation for it. For example, the professional might wrongly assume that the individual does not have a condition, because they have not seen the individual since that new condition developed.
Inconsistencies relating to the severity of needs
The confirmation from a professional might:
- state that the individual’s needs are higher or lower than
- of a different nature from
needs described elsewhere in the individual’s application.
For example, the professional may state that the individual does not have a high level of night time needs. However, the individual has told us they require a lot of care during the night.
The role of confirmation from a professional is not to confirm severity of needs or all details about how the condition impacts the individual..
Therefore, if the inconsistency does not relate to the broad confirmation of the individual’s conditions, disability or needs, you should move on to establish:
- the individual’s needs
- whether they meet the eligibility criteria in relation to the care and mobility components
Any information on severity of needs provided in the confirmation from a professional should be used in this step of the decision making process.
As with any inconsistency in additional supporting information, you should first establish whether the inconsistency is relevant and needs exploring. You should establish whether there is a reasonable explanation for this inconsistency. For example, if the professional has not seen the individual for some time, they might not be aware of a recent increase in the severity of their needs.
If you establish that the inconsistency needs exploring, you should proceed to do so as you would with any other piece of supporting information.
For example, an individual applies for CDP with a diagnosis of epilepsy. On their application, they describe having seizures which have become more frequent over the last 3 months. The seizures can occur at night which means that their parents have to provide much more care throughout the night. They explain they’re waiting for an appointment with their consultant.
They ask us to gather confirmation from their GP on their behalf. In the GP’s response they confirm that the individual has epilepsy. However, they explain that the condition was well-controlled at their last appointment 6 months ago and the individual did not have frequent seizures.
Although there is an inconsistency between the GP and the application in regards to the severity of the individual’s symptoms, the GP did confirm the individual’s condition. Therefore, the requirement of the confirmation from a professional has been met. You do need to explore the inconsistency but only in relation to the severity of the individual’s needs rather than their diagnosis of epilepsy.
When a confirmation from a professional is also additional supporting information
It is possible that one piece of information from a professional can at once act as both
- confirmation from a professional
- additional supporting information
You may use a piece of supporting information from a professional to confirm an individual’s conditions, disability or needs. This piece of supporting information may also contain additional information regarding the impact of the individual’s condition and their needs.
You should not disregard this information just because
- you have used the same document as the confirmation from a professional
- the application form provides enough detail for you to establish the individual’s entitlement
You should ensure that you are using any additional detail as additional supporting information.
However, you should be mindful that any additional detail provided in a confirmation from a professional is not used as a means to ‘evidence’ or ’proof’ of what the individual has told us in their application form. It should be used to inform your understanding of their needs.
For example, an individual may submit an outpatient’s summary written by a consultant alongside their application. In this summary, the consultant broadly confirms the condition of the individual. This is the confirmation from a professional. The summary continues to detail the symptoms of the individual and what the next steps in treatment are. This information is additional supporting information as it can be used to understand the individual’s level of needs and to establish their entitlement.
Requirements of the professional
The following information applies to both:
- professionals providing the confirmation from a professional
- professionals who provide additional supporting information
To provide supporting information, the professional or organisation should fall into one of the following categories:
- have been involved in the individual’s care, treatment, or everyday life for a period that would allow them to be familiar with their needs
- have carried out an assessment of the individual’s condition, disability or needs
- have the professional knowledge and access to records to provide an informed opinion on the individual’s condition, disability or needs
Professionals from the same organisation can provide supporting information, even if they have not been directly involved in that individual’s treatment or care.
They must have both:
- access to records on the individual
- the professional knowledge needed to understand these records
You do not need to obtain additional permission from the individual where the named contact at an organisation is not who will respond to the supporting information request.
For example, the GP who normally sees the individual and has been named on their application or review form might not be available. In this case it’s acceptable for a different GP from the same surgery to fill in the supporting information request form. This is because they have access to the individual’s medical record. It would not be acceptable for a member of staff who does not have medical training, such as a receptionist, to fill in the form.
Examples of who could provide this
This could include:
- social workers
- psychologists
- health professionals, such as nurses, GPs or consultants
- allied health professionals, such as physiotherapists or speech and language therapists
- education professionals, such as teachers or support teachers
- local authority staff who have access to Child’s Plan (under Getting it Right for Every Child, GIRFEC), an Additional Needs Assessment, or an individual’s care plan (such as homecare staff)
- health boards, such as Fife Health Board or NHS Health Scotland
- paid support workers who can confirm the level of care an individual receives
- third sector, private and other organisations or individuals who provide support to the individual
This list is not exhaustive
This list is applicable to professionals who work in both the public and private sector for example, private physio or a health care professional working for NHS. As long as they are familiar with the individual and their condition, disability or needs in a professional capacity, a professional from the private sector can provide supporting information.
Examples of supporting information from a professional
This could include:
- occupational health report
- treatment plans
- diagnosis
- appointment or referral letter
- social work report
- a list of medications prescribed to the individual
- care assessments or a care plan
- additional support needs plan
- medical specialist report
- information documenting the physical supports put in place by a local authority, such as a stair lift, ramp or accessible shower
Clara is 8 years old and is currently on the waiting list to be assessed for ADHD and autism. Through an online support group for parents, Clara’s parents have been encouraged to apply for CDP on her behalf.
However, they feel overwhelmed by the CDP application form and decide to seek help with completing it. They approach a local charity offering advice and support for people applying for benefits.
Clara’s parents attend the appointment without her. During the appointment they explain Clara’s needs to the member of staff in detail. The adviser has some basic knowledge on ADHD and autism, due to past applicants they have supported with disability benefits applications.
As Clara’s parents only have the referral letter for the ADHD and autism assessment, and are unsure whether this counts as confirmation from a professional, they decide to name the adviser who helped them fill in the application form as a professional contact on the form.
The case manager processing Clara’s application form recognises the organisation’s name. They are aware that the professional has most likely only met Clara’s parents once and, in all likelihood, does not know Clara and her needs well.
Therefore, they conclude that the professional is not familiar enough with Clara and her circumstances. As they do not have the necessary training to provide a qualified view on Clara’s needs, they would not be considered to be an appropriate source for the confirmation from a professional. The case manager reaches out to Clara’s parents to explain and ask whether:
- they have supporting information at home that might be suitable
- they could name an alternative contact, such as Clara’s school
Clara’s parents say that due to staff shortages and restructuring, her teachers have been overworked and will most likely be very slow to respond to a supporting information request. They are worried that this will delay a decision on their daughter’s CDP application.
They mention Clara’s referral letter which briefly summarises her needs. The case manager agrees that this would be an appropriate confirmation from a professional. Clara’s parents upload a photo of the letter. The case manager can proceed to making a determination on Clara’s entitlement to CDP.
Simon is 15 and over the past four months he has developed respiratory symptoms that make it likely that he potentially has a respiratory condition like asthma. He was referred to the Respiratory Team by his GP for further assessment.
During his first and only appointment, a Respiratory Nurse carried out spirometry tests to establish a diagnosis. While Simon and his family are waiting for his diagnosis to be confirmed, they apply for CDP.
They provide the contact details for his Respiratory Nurse as source of confirmation from a professional, as they are more familiar with Simon’s symptoms and potential condition than the GP.
The case manager accepts the specialist as an appropriate source of confirmation from a professional as, even though they have only seen Simon once, they:
- have carried out an assessment of Simon’s condition
- have the professional knowledge to provide an informed opinion on his likely diagnosis and prognosis
During the time between when Simon’s family applied for CDP and the case manager contacting the nurse for confirmation, the Respiratory Nurse interpreted Simon’s test results and report and concluded that Simon has severe asthma. They were able to provide the case manager with this diagnosis as confirmation from a professional.
Deciding whether a source is from a professional
The following guidance in this section is only applicable to the confirmation from a professional.
Deciding whether a source is a professional is important when deciding whether a document can be counted as a confirmation from a professional.
To help make a decision on this, you should use the information presented in this section as well as the pages on:
- Confirmation from a professional
- Additional supporting information
If the definitions already provided are not enough to make a decision, you should consider if the provider of the source:
- is being paid to provide a service to the individual
- is qualified or trained to provide their role to the individual
- has a personal relationship with the individual beyond their organisational role
- is acting within a formal capacity
- has specific skills or training to be able to provide support the individual
- has provided clear professional documentation, for example is it on letter-headed paper
- can be found by their details or credentials on official registers or systems, such as the Scottish Social Services Council, the General Medical Council, the Nursing and Midwifery Council or another professional regulatory body
- is still working in their field, for example they’re currently practising, not retired
This list is not exhaustive.
You should consider the answer to these questions and make a decision on a case-by-case basis. You should also consider the examples below.
If you conclude that it is more likely than not that a piece of supporting information is not from a professional, you should consider both:
- if you need to collect an alternative source as the confirmation from a professional, including how you work with the individual to source this information
- if the information can be used as additional supporting information
You may conclude that a source is not a professional but does contain information regarding the individual’s disability, condition or needs relevant to the application.
You should still consider this information as part of your decision-making.
Although it would not be a confirmation from a professional, it would count as additional supporting information. It would still count as this type of supporting information regardless of it was from a professional or the client’s wider support network.
If you want advice on how to classify a source of the confirmation from a professional, you can:
- speak to your line manager
- request a case discussion
A university student who works as an untrained babysitter for a family in their neighbourhood to supplement their incomes would be considered part of the individual’s wider support network.
This is because, even though they are paid for their service to the individual, they have not had any relevant training, nor hold relevant qualifications, to provide their role to the individual.
A volunteer who runs a social club in the local church on Sunday afternoons and regularly supports an individual when interacting with other children at the club belongs to the individual’s wider support network.
A volunteer runs a social club in their local community centre and is a retired social worker. They recognise the individual’s difficulties in most social interactions and have practised strategies with them that help the individual to avoid becoming overwhelmed easily.
However, this volunteer would not be considered a professional.
This is because the capacity in which they would be considered a professional would be through their status as a retired social worker. However, as they are retired, they no longer have the credentials to act in this capacity and are not active in their field.
Their testimony is still an important source of additional supporting information from the individual’s wider support network, but case managers should seek an alternative document as confirmation from a professional if the individual has not supplied one.