Making robust decisions – example section
Example: A case manager can make a robust decision without confirmation from a professional
Amelia is 10 years old and lives with her parents. She has a diagnosis of severe eczema, which has worsened over the last year.
In the application, Amelia’s parents explain that she experiences severe itching, broken skin, infections requiring regular antibiotics, and pain when moving her joints.
They describe significant care needs including a complex skin‐care regime completed three times a day, supervision to prevent scratching, and monitoring for infection. Amelia often cannot move comfortably and requires rest.
The case manager determines Amelia meets both the daytime and night-time conditions and is entitled to the highest rate care component as she requires frequent attention throughout the day and prolonged attention at night.
Example: An individual doesn’t provide enough detail to make a determination
Tommy is 7 years old. His father applies for Child Disability Payment due to suspected Attention Deficit Hyperactivity Disorder (ADHD). Tommy is currently on a waiting list for assessment and does not yet have a formal diagnosis.
In the application form, Tommy’s father describes him as being “hyper,” “not listening,” and “sometimes hitting out.” However, the information provided is vague and does not clearly explain how Tommy’s behaviour affects his daily care needs.
The application does not describe the frequency of these behaviours, the level of supervision required, or whether Tommy requires additional support with personal care or safety. No supporting information or confirmation from a professional is included with the application.
Based on the information provided, the case manager concludes that there is insufficient detail to determine whether Tommy meets the care component conditions.
The case manager contacts Tommy’s father by phone to gather further information. During this conversation, Tommy’s father provides limited clarification and responds briefly to questions, describing Tommy as “just lively” and explaining that “bedtimes can be difficult.” The responses do not provide enough detail to establish the level of support Tommy requires.
With consent from Tommy’s father, the case manager requests supporting information from Tommy’s school.
The school provides additional information outlining the level of support Tommy requires during the school day. They explain that Tommy requires 1:1 supervision during transitions around the school due to a risk of bolting. Staff report that Tommy can run suddenly without awareness of potential danger and therefore requires close supervision to ensure his safety.
The school also reports that Tommy experiences frequent toileting accidents and requires daily assistance. In addition, staff provide prompting and encouragement for Tommy to eat during meal times, as he can struggle to remain seated or focused long enough to finish his meals. Tommy also requires regular emotional reassurance and support to help him regulate his behaviour and manage distress.
This information enables the case manager to establish that Tommy requires frequent attention in connection with his bodily functions and a level of supervision that is substantially greater than would normally be expected for a child of the same age.
However, the case manager also notes that the school’s information highlights a significant risk of bolting, which requires close supervision during the day. Tommy’s father also mentioned that “bedtimes can be difficult,” although this was not explored in detail during the initial phone call.
Given Tommy’s impulsivity and the safety concerns described by the school, the case manager considers whether there may also be a need for supervision during the night. For example, if Tommy wakes during the night and attempts to leave his bedroom or the house, this could present a similar safety risk.
Before making a determination, the case manager therefore contacts Tommy’s father again to clarify whether there are any nighttime difficulties or supervision needs.
During this conversation, Tommy’s father explains that Tommy often wakes during the night and attempts to leave his bedroom. Because of this, his father needs to check on him and guide him back to bed. On some occasions Tommy has tried to go downstairs during the night, and his father reports needing to remain alert to ensure Tommy’s safety.
Taking all of the available information into account, the case manager determines that Tommy requires:
- frequent attention in connection with bodily functions (due to toileting accidents and support required afterwards), and
- substantial supervision to ensure his safety due to impulsive behaviour and bolting risk.
The case manager concludes that Tommy is entitled to the high rate care component, as he requires frequent attention throughout the day and a level of supervision that exceeds that normally required by a child of the same age.
Example: A decision is possible but difficult due to lack of information
In her application for Child Disability Payment, Aisha’s mother explains that her 11-year-old daughter has poorly controlled asthma. As a result of this condition, Aisha becomes very breathless and currently uses a reliever inhaler to help manage her symptoms.
Aisha’s mother describes the impact that breathlessness has on Aisha’s daily activities. Aisha requires assistance with washing and dressing, as even mild exertion causes her to become short of breath and experience wheezing. When washing, Aisha can become dizzy due to breathlessness and requires support to wash her hair and to get in and out of the bath safely.
These difficulties have previously resulted in injuries. Because of this risk, Aisha requires close supervision during personal care activities. Her breathlessness also affects her ability to reach the toilet in time, which has led to occasional toileting accidents. As a result, Aisha’s mother provides additional support with moving around the house and with maintaining personal hygiene, including additional washing and bathing.
When moving around the house, Aisha needs to pace herself, often requiring frequent rest breaks.
Her symptoms are often worse during the night and in the early morning. At these times, Aisha may struggle to breathe, cough frequently, and experience tightness in her chest. These symptoms can prevent her from sleeping through the night and can also leave her feeling dizzy and drowsy.
Aisha’s mother explains that she must ensure Aisha is propped up in bed, as Aisha struggles to breathe when lying flat. If Aisha slides down in bed, her breathlessness can worsen. During the night, Aisha’s mother also administers her inhaler, as Aisha can become panicked when experiencing breathing difficulties. Afterward, she helps Aisha settle back to sleep due to how distressed she becomes. Aisha’s mother reports that this occurs most nights of the week and typically takes at least 30 minutes from the onset of symptoms to settle Aisha again.
Aisha also experiences acute asthma exacerbations which can occur suddenly. During these attacks, her symptoms worsen significantly and she struggles to breathe.
Although Aisha’s mother did not provide confirmation from a professional with the application, she provided the contact details of Aisha’s GP, who sees her regularly for check-ups.
Based on the information provided and existing knowledge, the case manager identifies a significant inconsistency between the severity of the needs described and the level of medication and clinical management currently recorded. Individuals with poorly controlled asthma would typically be prescribed more intensive medication and may be under the care of a specialist.
Due to this inconsistency, the case manager determines that they are unable to make a robust determination based solely on the available information. On the balance of probabilities, it appears unlikely that a child experiencing the level of need described would not be receiving specialist input or more advanced treatment.
The case manager considers this inconsistency significant because there is conflicting information regarding the severity of Aisha’s condition. As Aisha is seen regularly by her GP, it would be expected that appropriate medication would be prescribed and that a referral to specialist services would have been made if clinically required.
To clarify this inconsistency, the case manager requests supporting information from Aisha’s GP.
The GP provides a brief statement confirming that Aisha was recently admitted to hospital following a significant asthma flare-up. The GP confirms Aisha’s diagnosis and outlines her current prescriptions. The GP also explains that:
- Aisha’s symptoms have only recently deteriorated
- She has recently been referred to a specialist and is likely awaiting her first appointment
- Her medication is currently under review
Although the GP’s confirmation does not include detailed information about Aisha’s care needs, this is acceptable. The purpose of confirmation from a professional is to broadly confirm the individual’s condition, disability, or needs.
As the additional information resolves the inconsistency between the severity of symptoms, medication, and clinical management, the case manager now has sufficient information to proceed. They are able to:
- establish the facts of the case
- reach a conclusion of law
The case manager determines that Aisha is entitled to the higher rate of Child Disability Payment, as she satisfies both the daytime and night-time conditions. Aisha requires frequent attention throughout the day in connection with her bodily functions, and prolonged attention at night.
Her award will begin once she has satisfied the backwards test. A review date of 18 months is set, as Aisha’s symptoms may be significantly more manageable if her asthma is better controlled.
Example: A case manager establishes whether confirmation from a professional is needed and an inconsistency needs to be explored
Maria is 9 years old. Her mother applies for Child Disability Payment due to Maria having epilepsy.
In the application form, Maria’s mother explains that Maria experiences frequent seizures, which can occur without warning. She states that Maria requires close supervision throughout the day because seizures can happen suddenly and may place her at risk of injury. Maria’s mother explains that she needs to supervise Maria during activities such as bathing and when moving around outside the home.
The application also describes night-time difficulties. Maria’s mother explains that Maria can experience seizures during the night and requires regular monitoring. She checks on Maria frequently and keeps monitoring equipment nearby to ensure she can respond quickly if a seizure occurs.
The application includes a prescription for anti-epileptic medication and a hospital appointment letter indicating that Maria is under the care of a paediatric neurology service.
Maria’s mother also notes in the application that Maria sometimes struggles with her speech and is attending speech and language therapy. However, the application does not provide detailed information about the frequency or impact of these communication difficulties, and no supporting information from speech and language therapy is included.
The case manager considers whether confirmation from a professional is required to verify Maria’s speech and language difficulties.
The case manager notes that the information already provided confirms Maria’s epilepsy diagnosis and ongoing specialist involvement. The level of supervision and attention described in relation to Maria’s seizures indicates that she requires frequent attention in connection with her bodily functions and supervision to ensure her safety throughout the day and night.
The case manager concludes that Maria’s epilepsy alone is sufficient to meet the conditions for the relevant care component.
Although there is limited information about Maria’s speech and language difficulties, the case manager determines that seeking confirmation from a speech and language therapist would not change the outcome of the determination. The existing information already demonstrates that Maria’s care needs meet the entitlement conditions.
Requesting additional confirmation would therefore not provide additional information that is necessary to establish the facts of the case and would likely delay the determination unnecessarily.
The case manager decides that it is not proportionate to request further supporting information regarding Maria’s speech and language difficulties. They proceed with making a determination based on the information already available.
This ensures that Maria’s award can be made without unnecessary delay while still ensuring the determination is based on sufficient and reliable information.