Exception: Review periods under 2 years
In exceptional circumstances, you can set review periods of less than 2 years. This should only be done when it is clear from the information available on the individual’s circumstances that their condition is likely to change significantly before the 2 year mark.
You must make sure that the individual is likely to meet the forwards test.
You should consider the available information to:
- understand the individual’s prognosis
- decide if a review period under 2 years is appropriate
Setting a review period under 2 years could be appropriate due to one of the following having a significant impact on the individual’s needs:
- scheduled surgery planned beyond the longest possible time period for delaying a review where the individual has requested that delay scheduled, staged corrective surgery
- scheduled, staged corrective surgery
- the individual recently starting new treatment likely to have a significant impact on their needs
- the individual soon completing treatment likely to have a significant impact on their needs once recovered
- it being difficult or impossible to anticipate how the individual’s needs will develop between 39 weeks (ADP forwards test) and 24 months from now. This could be due to a degenerative condition where the individual’s needs are expected to increase but the pace of change is unclear
- the individual soon beginning a new phase in their life likely to have a significant impact on their needs, for example moving into adapted accommodation
This list is not exhaustive.
Setting a review period of under 2 years may be appropriate if it is impossible to anticipate how the individual’s needs will develop beyond that time.
Case managers must make sure that this lack of clarity is not simply due to any of the following:
- a lack of knowledge of the individual’s condition
- gaps in the application, review form or in supporting information that they have not yet explored with a Health and Social Care practitioner, the individual or the professional who provided the supporting information in question
- a lack of general confidence and experience regarding setting review periods
If any of these bullet points apply, you must request a case discussion with a Health and Social Care practitioner to discuss what an appropriate review period would be.
Example: an individual’s award of ADP will be reviewed in 12 months
Oakley is 21 years old. In their application, they explain that they were diagnosed with anorexia nervosa at age 17 and have been under the care of specialist psychology and dietetics services. Oakley states that they are making positive progress and has been slowly gaining weight, but that they continue to require prompting with preparing food and taking nutrition. The impact of Oakley’s condition means that they are experiencing fatigue and lack of energy because of limited nutrition.
Both the application form and the supporting information suggest that input from physiotherapy and occupational therapy has been focused on helping Oakley to pace themselves and manage their fatigue.
Based on the information available, the case manager establishes that Oakley’s needs are highly likely to change in the near future. Setting a longer review period therefore would not be appropriate.
To establish the point in time when Oakley’s needs are likely to have changed, the case manager reviews the information provided by Oakley again. The supporting information obtained from dietetics indicates Oakley is making good progress and will likely be discharged from the service in the next six months. The case manager expects that it will take some time afterwards for Oakley’s needs to stabilise. They request a case discussion to get advice on how long this period is expected to be. The practitioner explains that, based on Oakley’s current progress it would be reasonable to expect their situation will have stabilised 6 months after they are discharged.
Based on the case discussion, the case manager determines that it would be appropriate to follow the exceptions guidance on setting a review period, and sets a review of Oakley’s award for 12 months, as it is important to see if Oakley can maintain a stable weight and begin to manage these activities without prompting.
Oakley’s determination letter informed them that their award would be reviewed in 12 months. We explained that this review period had been set in light of the positive progress they were making with their current treatment. We advised that, at review, Oakley would need to update us on preparing food and taking nutrition daily living activities to better understand how their needs have changed following their current treatment.
Example: An individual’s award of ADP will be reviewed in 18 months
David is 54 years old and he had a stroke 8 months ago. He was admitted to hospital for 10 days where he received clot-busting medication. David has been left with right side weakness to his arm and leg.
David has been attending physiotherapy and has been making progress with strengthening and moving his right arm and mobilising. In his application for ADP, he explains that:
- after discharge from hospital, he has been continuing to see the physiotherapist once weekly for strengthening exercises to his right arm and leg
- there has been an improvement.
In a letter submitted by David as confirmation from a professional, the consultant has advised that with the progress David is making in physiotherapy, there should be significant improvement in the next 12 to 18 months. The case manager determines that due to the expected improvement in David’s condition, a review in 18 months would be appropriate.
David’s determination letter informed him that his award would be reviewed in 18 months. The case manager explained that this review period had been set due to the ongoing progress he was making with his physiotherapy. He was advised that, at review, David should provide an update on his needs related to the daily living and mobility activities he was awarded as we expect his level of needs are likely to change.
Example: An individual is given a review period of 21 months
Nancy is 61 years old and experienced a significant impact to her health when she suffered a heart attack, resulting in severe complications, including infection following a stent, which further complicated her recovery process. Nancy applies for ADP four months after her heart attack, satisfying the backwards test.
In her application form, Nancy explains she is on a home intravenous antibiotic regimen, which is administered every day for 6 months. Nancy has a PICC line in her arm and due to awkward positioning Nancy requires assistance to manage this. Once the infection has cleared she may be a candidate for valve replacement as the infection damaged her heart valve. She has an appointment with a cardiologist specialist monthly.
Due to her cardiac issues Nancy experiences low blood pressure which causes nausea and dizziness. She requires assistance when standing and to balance when she has to get up from the chair as this makes it worse. She is exhausted with the slightest tasks, and requires assistance with getting washed and dressed. She has to nap following this due to the exertion.
Her diet is restricted to prevent overloading on fluids and she has to follow a dietary fluid restriction, as she has developed kidney problems which are a known comorbidity.
Nancy's ability to mobilise has been significantly impacted by her heart attack and she has been provided with a zimmer frame by physiotherapy due to fatigue and breathlessness.
A medical report submitted as confirmation from a professional sets out that, according to her doctors, Nancy’s recovery from the heart attack is expected to be longer than conventional recovery and requiring close monitoring.
In order to set an appropriate review period, the case manager requests a case discussion to find out more about Nancy’s likely recovery time. The Health & Social Care practitioner explains that it is expected that stabilisation of Nancy’s heart is to be achieved by 6-9 months. Nancy will then require cardiac rehabilitation to regain strength and function with the hope of a successful recovery over the next 12-18 months.
The case manager determines that Nancy is entitled to the enhanced rate of both the daily living and mobility component. They set a short review period of 21 months, as Nancy has had an acute illness that with appropriate treatment and rehabilitation has potential to recover appropriately within this timeframe.
Nancy’s decision letter told her that we would review her award in 21 months. It explained that we had chosen this review date, as it should allow Nancy time for her level of needs to change in this time period. She was advised that we would be seeking an update on her level of needs following her ongoing treatment and rehabilitation.