Exception: Indefinite awards (awards without a review date)

Indefinite awards are awards without a review date.

Indefinite awards should be given in the rare case where setting a review date would not be appropriate. This is the case where the available information suggests the individual is entitled to both

• the enhanced rate of the daily living component of ADP
• the enhanced rate of the mobility of ADP

and their significant level of need is either:

• highly unlikely to change in the long term;
• only likely to increase.

Case managers should base their decision to give an indefinite award on the holistic picture of the individual’s circumstances, rather than on the individual’s condition alone. The condition is only one of many aspects that need to be considered. These aspects are set out below.

Setting indefinite awards

Case managers must request a case discussion in all cases before making an indefinite award. This is because decisions on indefinite awards can be highly complex.

The case discussion must focus on whether not setting a review date is appropriate. This is a mandatory step. For more information on the process involved in making an indefinite award, case managers should refer to operational guidance [LINK TO RELEVANT OPS GUIDANCE CHAPTER].

It is important that before deciding not to set a review date, the case manager must gather enough information to make this decision. If the case manager incorrectly chooses not to set a review date, this may mean an individual continues to be paid the wrong rate of assistance.

If an individual has expressed a clear view that they would not be comfortable with an indefinite award, the case manager should respect this and set a review period that is appropriate for this individual. This is because for some people, not having any future reviews of their award can be anxiety inducing.

Individuals may express this, for example:

• In their application or review form
• When speaking to a case manager on the phone

During a consultation with a practitioner. At the moment, case managers should avoid proactively raising the topic of indefinite awards when speaking with individuals and should not reach out to individuals simply to ask whether they would be comfortable with an indefinite award. A process for this will be developed shortly.

Relevant factors when considering giving an indefinite award

Whether the needs of an individual with a lifelong condition are highly unlikely to change depends on a range of factors, including:

• the rate of both ADP components the individual is entitled to [LINK TO SECTION BELOW]
• Their age [LINK TO SECTION BELOW]
• Single or multiple conditions [LINK TO SECTION BELOW]
• The duration of their condition [LINK TO SECTION BELOW]
•  Natural progress of the underlying condition
• The conditions the individual might have, and whether there is likely to be an improvement or deterioration in the individual’s condition or the impact it has on the individual [LINK TO SECTIONS BELOW]
• Any planned or likely treatment or surgery that is likely to lead to an improvement in the condition [LINK TO SECTION BELOW]

This list isn’t exhaustive.

It is essential that case managers consider all relevant factors to build up a holistic picture of the individual’s circumstances and the likelihood of their needs changing over time.

The rate of both ADP components the individual is entitled to

Only individuals who are on the enhanced rate of both

• The daily living component
• The mobility component

Can be considered for an indefinite award.

Individuals whose needs are highly unlikely to change but who do not meet this criterion because they are entitled to either the:

• enhanced rate of the daily living component and the standard rate of the mobility component;
• standard rate of the daily living component and the enhanced rate of the mobility component
• standard rate of the daily living component and the standard rate of the mobility component
• enhanced rate of the daily living component and not the mobility component
• the standard rate of the daily living component and not the mobility component
• enhanced rate of the mobility component and not the daily living component
• standard rate of the mobility component and not the daily living component should be given a long review period (5 - 10 years) [LINK TO SECTION LONGER REVIEW PERIODS (5 TO 10 YEARS) ABOVE]

Age

Single or multiple conditions

An indefinite award may not be appropriate if one or more of the individual’s conditions is likely to change.

However, a case manager should consider the likelihood of changes to the individual’s overall level of need, rather than the likelihood of one of their conditions changing.

Duration of condition

There is no requirement that an individual must have had a condition for a certain period of time before they may be eligible for an indefinite award. However, the individual must satisfy the backward and forward tests.

In some cases, the condition itself is likely to be so severe and enduring that it is appropriate to make an indefinite award shortly after the onset of the individual’s condition or disability.

Alternatively, it may be that the individual has tried a number of treatments which have not lessened the impact of their condition. This would again suggest an indefinite award is appropriate.

In other cases, the condition may be affected by a planned course of treatment or surgery, or may change in impact as the individual adapts to it. In this case it is less clear that the individual will not experience any changes.

Planned treatment or surgery

If an individual with multiple conditions has a surgery scheduled or treatment planned which addresses one or several of their conditions, an indefinite award may still be appropriate if their overall level of need will not be affected by this treatment.

Natural progress of the underlying conditions

Considering an individual’s conditions and understanding how they are likely going to be impacting the individual over time is one of the important factors to consider during this decision-making process.

Conditions can be categorised according to their likely progression over time. Considering this is important when making a decision on whether or not setting a review period might be appropriate. Fluctuating conditions

Case managers should allow for short-term periods of change in the level of need, if the individual has a fluctuating condition. If the individual’s needs are highly unlikely to fluctuate beyond what can be expected based on their condition the case manager should consider giving an indefinite award.

Example: an individual has a lifelong condition that is unlikely to change

Esther is 56 years old and was first diagnosed with schizophrenia at age 26. They live on their own in a rented flat and have current input from mental health services, who have been providing input for thirty years and takes significant levels of mental health medication.

Esther is supported by twice weekly support sessions from a mental health support worker and daily home care visits. Schizophrenia is a lifelong condition with low probability of full remission, with symptoms remaining stable and enduring.

Esther reports that they have learned to live with their condition and their main restrictions are self-care and when they come into contact with other people.

Care staff report that they

• need supervision or assistance to either prepare or cook a simple meal;
• will not wash unless prompted;
• will not change their clothing unless prompted;
• are unable to engage with people at all without overwhelming anxiety
• struggle to deal with financial matters due to this.

The case manager awards the following points for the daily living component:

1(e): 4 points

4(c): 2 points

6(c): 2 points

9(d): 8 points

10(b): 2 points

Care staff report that they can go out on the majority of days, however require to be accompanied due to the symptoms of their condition.

The case manager awards the following points for the mobility component:

1(f): 12 points

The case manager checks the decision-making guidance on review periods and notes that Esther’s condition is on the list with conditions that suggest a review may be inappropriate (Pathway 2). The case manager seeks input from a practitioner on Esther’s condition and whether setting a review date would be appropriate. Based on the practitioner’s advice, the case manager identifies that Esther has a lifelong condition, which they have had for over thirty years. Although there are likely to be small changes in need, it is highly unlikely due to the length and nature of condition that their condition will change. The case manager decides it would be reasonable to award an indefinite award based on the likely longevity and complexity of their condition. They make the determination and submit the case for internal quality assurance.

Progressive condition

A progressive condition is a disease or health condition that gets worse over time, resulting in a general decline in health or function. The term ‘progressive condition’ is often used to distinguish a condition from a relapsing and remitting condition. Depending on the condition, a progressive condition may progress quickly or very slowly.

Relapsing and remitting conditions

In a relapsing and remitting condition, there is often a period when the condition is stable for a while or is in remission. In contrast, a progressive condition does not have these breaks.

Permanent

A permanent condition is a condition that will not change and for which there is no treatment or cure. Examples are blindness, spinal injury, or brain injury.

Example: a permanent condition that is unexpected to change

Mohammed has quadriplegic cerebral palsy, a condition caused by a shortage of oxygen to the brain before or during birth. This leads to him being unable to co-ordinate movement in his arms and legs. This is a lifelong condition. Mohammed states in his application that he requires full-time care. He has indicated difficulties under activities 1, 2, 4, 5, 6, and 7 and the case manager awards the following points for the daily living component:

1(f): 12 points

2(f): 10 points

4(g): 8 points

5(c): 2 points

6(f): 8 points

7(c): 4 points

For the mobility activities Mohammed reports that he is able to plan the places where he needs to go, but uses a wheelchair for moving around. The following points were awarded:

2(f): 12 points.

After familiarising themselves with Mohammed’s case, the case manager requests a case discussion to discuss whether an indefinite award might be appropriate. After seeking input from a practitioner, the case manager knows that it is highly unlikely that Mohammed’s condition will change, therefore it is reasonable that an indefinite award would be appropriate in this case. The case manager determines that Mohammed should receive an indefinite award and submits their determination for mandatory quality assurance.

There is no requirement for the individual to have a terminal illness in choosing not to set a review date. Individuals who have a terminal illness will not have a scheduled review of their entitlement. Special rules for terminal illness awards are ongoing without review. There will be no review period and an individual remains eligible unless they have informed Social Security Scotland that their circumstances have changed. For more information on making a determination on a terminal illness case please refer to the SRTI chapter [LINK].

Specific conditions and indefinite awards

In all cases, an individual must be entitled to the enhanced rates of the daily living and mobility component of Adult Disability Payment, before the case manager can consider setting an indefinite award.

Case managers should consider whether the individual has a condition on either of the following lists:

• conditions that suggest a review is inappropriate (called Pathway 1)
• conditions that suggest a review may be inappropriate (called Pathway 2)

The first list refers to a number of conditions that are likely to mean the individual has a stable level of needs and it is highly unlikely that the individual’s condition will improve. Please see the accompanying guidance on this list .

The second list refers to a number of conditions that potentially mean the individual has a stable level of needs but it is possible that the individual’s condition may improve. Please see the accompanying guidance on this list.

If the individual has a condition or multiple conditions that do not appear on the list, the case manager should nevertheless go on to consider whether the individual’s overall condition is highly unlikely to improve [LINK TO SECTION BELOW: