An individual reports no change to their level of needs or condition(s). This is in line with our expectations, as based on the information on their award, we were not expecting to see a change.

Child has a complex genetic condition involving medical needs and learning disability. Due to their underlying genetic (and therefore lifelong) condition, this will not be expected to change and neither will the needs associated with it, especially in light of the lifelong learning disability.

The case manager should aim to conclude the award review quickly.

If the case manager decides that it is unlikely that the individual’s conditions or needs will change, they should set a long review period (between 5 and 10 years).

If the case manager decides that it is highly unlikely that the individual’s conditions or need will change, the case manager should consider setting the review period to their 18th birthday, even if this would exceed the 10-year maximum review period.

An individual reports no change to their conditions or level of needs. This is not in line with our expectations, as based on the information on their award, we were expecting to see a change.

Child born with Talipes (clubfoot) – it would normally be expected that, following the period of prescribed treatment (casting, minor surgery, wearing boots and bar), the condition would be resolved and therefore the child’s care needs would decrease.

The case manager should both:

• treat this as an inconsistency
• proceed as usual when exploring inconsistencies in information to establish whether the inconsistency is relevant.

This could, for example, involve checking guidance or requesting a case discussion.

If the inconsistency is indeed relevant, they should choose from the set of options below to explore and resolve it:

Contact the individual to ask follow-up questions. Here, case managers must ensure that this phone call does not become, or feel to the individual like, a de-facto consultation. For more details, see operational guidance on contacting individuals with follow-up questions.

Choose the decision-making tool that is most appropriate/ most likely to provide the information they need.

There are a number of decision-making tools for case managers to use:

• Consulting guidance (DMG, Operational Guidance, Medical Guidance)
• Case discussion
• Requesting supporting information.

Supporting information:

• is just one of several decision-making tools
• should not be the default step to take

when establishing the individual’s level of need.

Rather, the case manager should choose the action based on what’s most appropriate in the review at hand. As part of that consideration, they should consider what’s best for the individual. For example, a quick phone call to the individual to ask a follow-up question might be better than the individual having to:

• collect supporting information from their wider support network
• wait a number of weeks until the case manager’s request for supporting information has been answered by the contact the individual has provided.

If the case manager decides that gathering supporting information is the most appropriate decision-making tool, they need to decide which source would be best-placed to provide the information they need. This can be a professional or a member of the individual’s wider support network. Crucially, requesting supporting information should be done with the goal to more fully understand the individual’s new level of needs. The aim here is not to “verify” what the individual has told us.

An individual reports a change of circumstance to a condition we are aware of. Based on what we already know about the individual, this change was expected.

I.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs) or good cause for not having confirmation from a professional (i.e. the ‘one piece’) has previously been established.

Example: A young child with Global Developmental Delay/Learning Disability – whilst this condition is not going to change, due to the child’s growth and development, the gap between the ability of them and their peers widens, therefore additional support/care needs would be expected.

Here, we wouldn’t want to see confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs). The case manager can go on and establish the individual’s new level of need and make a determination of entitlement.

I.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs) that had been previously provided does not relate to the condition the reported change relates to.

Here, there are two possible outcomes:

Firstly, if the reported change is not likely to lead to a change in their award level, we would not want to see confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs). The case manager can go on to make a determination of entitlement. If more detail on the individual’s new level of need is required, the case manager should take the steps set out in the section ‘Needing more detail to establish the new level of need'.

Secondly, if the reported change is likely to lead to a change in their level of award, we would want to see confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs). For example, their level of award could change from the lower to the higher rate of the mobility component.

The change of circumstance reported by the individual could, for example, be a change that turns a previously minor condition with low to no impact on an individual’s level of award into a condition that now significantly impacts their level of entitlement. However, before reaching out for confirmation from a professional case managers should discuss with a practitioner. It is possible the ‘new’ condition is a complication / progression from the original condition. If this is the case, confirmation from a professional is not necessary. Practitioners input should be sought before reaching out for confirmation from a professional.

Once either:

• confirmation from a professional has been provided
• good cause for not having confirmation from a professional has been established or
• it has been established the new condition is linked or a likely progression given the previous condition

the case manager can go on and establish the individual’s new level of need and make a determination of entitlement. If more detail on the individual’s new level of need is required, the case manager should take the steps outlined above.

An individual reports a change of circumstance to a condition we are aware of. Based on what we already know about the individual, this change was not expected, for example because:

• we expected the condition or their needs to not change, or
• we weren’t expecting a change of this nature.

Previously, either:

• the individual has provided confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs) on this condition
• good cause for not having confirmation from a professional (i.e. the ‘one piece’) has been established.

Here, we would not want to see confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs).

The case manager should both:

• treat this as an inconsistency
• proceed as usual when exploring inconsistencies in information to establish whether the inconsistency is relevant.

This could, for example, involve checking guidance or requesting a case discussion. If the inconsistency is indeed relevant, they should choose from the set of options below to explore and resolve it:

• Contact the individual to ask follow-up questions. Here, case managers must ensure that this phone call does not become, or feel to the individual like, a de-facto consultation. For more details, see operational guidance on contacting individuals with follow-up questions.
• Choose the decision-making tool that is most appropriate/ most likely to provide the information they need.

There are a number of decision-making tools for case managers to use:

• Consulting guidance (DMG, Operational Guidance, Medical Guidance)
• Case discussion
• Requesting supporting information

Supporting information:

• is just one of several decision-making tools
• should not be the default step to take

when establishing the individual’s level of need.

Rather, the case manager should choose the action based on what’s most appropriate in the review at hand. As part of that consideration, they should consider what’s best for the individual. For example, a quick phone call to the individual to ask a follow-up question might be better than the individual having to

• collect supporting information from their wider support network
• wait a number of weeks until the case manager’s request for supporting information has been answered by the contact the individual has provided.

If the case manager decides that gathering supporting information is the most appropriate decision-making tool, they need to decide which source would be best-placed to provide the information they need. This can be a professional or a member of the individual’s wider support network. Crucially, requesting supporting information should be done with the goal to more fully understand the individual’s new level of needs. The aim here is not to “verify” what the individual has told us.

An individual reports a change of circumstance. The change is a new condition that Agency wasn’t previously aware of.

Example: A 5 year old child presents with a moderate learning disability. A change of circumstance is reported that the child has been diagnosed with epilepsy. It is reported that the epilepsy is well-controlled with medication. As the epilepsy is well-controlled and does not appear to impact functioning, as the child’s care needs have been considered in light of their learning disability, there would be no changes to entitlement.

Here, we would not want to see confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs) to confirm the individual’s new condition. We can make a determination based on what we have available.

It is possible that a case manager:

• initially thinks that the reported change will not impact on the individual’s level of entitlement
• further along the decision-making process understands that the individual’s award will change after all.

If this is the case, the case manager should move to Scenario 5b below and seek confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs) in relation to that condition.

Example: A 5 year old child presents with a moderate learning disability. A change of circumstance is reported that the child has been diagnosed with epilepsy, however they are awaiting specialist assessment as their epilepsy is poorly controlled, reporting unpredictable seizures most days. As the child’s care needs would be expected to increase due to the epilepsy condition, there are likely changes to entitlement expected.

Here, case managers should seek confirmation from a professional (i.e. one piece of supporting information from a professional to broadly confirm the individual’s conditions, disability or needs) in relation to that condition. If that’s not possible, the case manager should see whether

However, before reaching out for confirmation from a professional case managers should discuss with a practitioner. It is possible the ‘new’ condition is a complication / progression from the original condition. If this is the case, confirmation from a professional is not necessary. Practitioners input should be sought before reaching out for confirmation from a professional.

If more information is needed to understand the individual’s new level of need, the case manager should take the appropriate steps outlined above.