Relevant considerations for setting a review period

A review date should be set based on when the individual’s circumstances are likely to have changed. The case manager should take a holistic, person-centred approach to determine when this is the case for the individual in question. This means that they should not set a review period based only on when, generally, individuals with a certain condition may experience changes. Rather, the case manager should also consider:

• the application form or review form completed by the individual or on their behalf
• (if applicable) additional information gathered by contacting the individual with follow-up questions
• confirmation from a professional, if available
• (if applicable) any supporting information provided by the individual, or collected by Social Security Scotland
• (if applicable) advice from a Social Security Scotland practitioner
• (if applicable) the consultation report supplied by a practitioner
• (if applicable) information received from DWP when an individual’s entitlement to Personal Independence Payment or Disability Living Allowance is transferred to Adult Disability Payment
• the factors outlined in this section to determine when the individual’s needs will likely change in the future.

Although some conditions might suggest a longer review period (or none at all), case managers should make a decision based on the information available to them relating to the individual and the holistic picture they’ve established based on that information.

Where there is more than one condition, the case manager should take into account the effects of all of the conditions. This should also involve considering how those conditions interact with each other and what their overall impact on the individual is.

If the information available on the individual does not provide a case manager with this level of detail, it may be appropriate to consider one of the following: 

• seeking a case discussion with a practitioner
• where a consultation with the individual has already been identified as necessary to establish the level of need case managers could request that the consultation also provides the information needed for setting a review period by adding relevant questions to the consultation request. This should only be done when a consultation is needed to establish the individual’s level of need. Case managers should never request a consultation solely to understand what review period to set.
• The following factors are all relevant in setting an award review date:
• the age of the individual whether the individual is entitled to the enhanced rate of both Adult Disability Payment components and might therefore be eligible for an indefinite award
• whether the individual has a single condition or multiple conditions
• how long the individual has had their condition
• whether there is any ongoing, current or future treatment or surgery and how this might be expected to impact the individual’s level of needs
• the type and anticipated progress of the underlying condition
• relevant life events

Establishing how these factors interact with one another and, based on them, what review period (if any) will be appropriate, can be complex. Case managers should request a case discussion if they need support to select an appropriate review period.

Age

The individual’s age can impact on the likelihood of their needs changing over time. For example:

• The age at which an individual first develops or experiences their condition may impact their ability to adapt to that condition.
• Depending on their age, individuals might have different support available: a younger person may have parental support to manage a condition and an older person may have a family to help, both may impact how they deal with their condition.
• Age influences the likelihood of the individual being in good health. If an individual is in good health, it is more likely that they will adapt quickly to a new condition or disability or will recover more fully. This list is not exhaustive.

It is impossible to be prescriptive about the effects of age in all cases. Case managers should be cautious about assuming that an older individual is likely to have longer-term needs than a younger individual.

It might be reasonable to expect that a 25-year-old in good health, who loses their left leg in an accident, might adapt to this and live independently. They may be able to adapt quickly to using a prosthetic leg and benefit from intensive physiotherapy.

However, a 60-year-old individual who is:

• overweight
• has diabetes
• has a number of respiratory conditions

and who loses their leg because of complications from diabetes is more likely to face longer-term needs. Their existing conditions are likely to impact

• wound healing
• muscle strength
• the new muscle and joint movements required with prosthetic limb use.

If a case manager is unsure about whether the individual’s age is more likely to give rise to longer-term needs, they should request a case discussion with a practitioner.

Level of award (enhanced rate of both components)

If an individual is entitled to the enhanced rate of both components of ADP the case manager should consider whether they meet the eligibility criteria for indefinite awards (awards without review).

Indefinite awards are only appropriate for a small group of individuals in receipt of the enhanced rate of both ADP components whose needs are highly unlikely to change or only likely to increase.

Apart from individuals who are terminally ill, there is no automatic process to make an indefinite award, simply because the individual is entitled to the enhanced rate of the daily living and mobility components.

Case managers must review the decision-making guidance on indefinite awards and must follow the process set out in the operational guidance [LINK TO THE RELEVANT OPS GUIDANCE CHAPTER].

Case managers should consider all of the information available from the application or review form and supporting information in deciding whether or not to set an award review period. Single or multiple conditions 

In the case of a single condition, it may be relatively easy to understand if the individual’s condition is unlikely to change.

Where the individual has multiple conditions, it may be much more challenging to assess the likelihood of a change in their level of need.

Where the individual has multiple conditions, it is likely that planned treatment or surgery may not improve their overall level of need. Case managers should therefore consider carefully the extent to which any treatment or surgery will likely change the individual’s overall level of need. 

Even if one or several conditions an individual with multiple conditions has are likely to change over time, they might still be eligible for an indefinite award if both:

• They are entitled to the highest rate of both components of ADP
• Their overall level of need is highly unlikely to improve over time. If the case manager is unsure about whether the individual has one or more conditions that are likely to change, they should request a case discussion.

Length of time individual has had the condition

Individuals who only recently acquired a new condition might still be adjusting to their disability.

For example, they might still be learning how to use aides enabling them to walk. This might impact the likelihood of their needs changing in the future.

Case managers must not set a review period solely based on the duration the individual has had their condition. Case managers should consider all other factors discussed in this section and how they apply to the individual in question when setting a review period.

The length of time an individual has had a condition is not the same as the recency of a diagnosis of a condition. An individual may have had their condition for a long period of time and may have learned to adapt (e.g. by self-medicating, avoiding certain environments or movements, relying on support from others, or using aids) before they get diagnosed.

However, a recent diagnosis can lead to new and potentially more appropriate treatment or support becoming available, which the individual then will need time to adapt to. This is likely to impact on their level of needs.

Ongoing, current or planned treatment or surgery

If the supporting information suggests that the individual is either

• currently undergoing
• likely to undergo soon

a planned course of treatment or surgery that is expected to improve their overall condition or level of need, case managers should schedule a review after this, taking into consideration the recovery period and possible rehabilitation.

Not all treatment or surgery will lead to a change in needs. Individuals might also receive treatment or undergo surgery to maintain their current level of needs. This could be the case, for example, if they have a degenerative condition. If unsure whether a scheduled review would be necessary after an upcoming course of treatment or a planned surgery, case managers should request a case discussion.

Where the individual has multiple conditions, it is likely that planned treatment or surgery may not improve their overall level of need. Case managers should therefore consider carefully the extent to which any treatment or surgery will likely change the individual’s overall level of need.

In the case of planned treatment, this may take place over a period of days, weeks or months. The review date should be a reasonable time after the planned treatment ends.

In the case of surgery, the review date should be a reasonable time after the surgery is due to take place. This should include time for any recovery.

What is reasonable will vary in every case, depending on the complexity of the treatment or surgery. It will also depend on whether the individual has any other health conditions, as well as whether any complications are common for a time after either.

If the case manager needs guidance on likely recovery times, they should request a case discussion with a practitioner. 

Many individuals will be receiving ongoing or regular treatment, or take medication, to manage their conditions or disability. Medication can have side effects that can impact on an individual's overall level of need.

The likelihood of the individual’s needs changing might also be impacted by the amount of time they have been taking their medication.

For example, due to drug resistance and increased tolerance over time, it is possible that the impact of an individual's medication on their level of need will change over the course of their prescription. For more information on medications refer to Drugs A to Z | BNF | NICE

Similarly, it can take time and multiple trials for an individual to receive medication that is effective and manageable for them. For example, an individual who is newly diagnosed with ADHD may just have begun their first trial of medication, and have yet to receive any support to allow them to self-manage their condition. Based on their condition and information on the medication, it can be expected that they may require a couple of ADHD reviews and medication changes to find a medication that works well for them, and to learn how best to manage their condition. Here, a shorter review period may be reasonable. In contrast, an individual with ADHD who

• has tried numerous medications over the past 10 years
• is aware of self-management techniques may have more stable needs. Here, a longer review period may be appropriate.

Condition

Case managers should take into account the prognosis of the individual’s condition.

It is important to remember that the typical features of a health condition might not apply to every individual. The presence or absence of these features may still be relevant to the award review date, as a case manager should set the review date when needs are likely to change.

If it is unclear what the natural progress of a health condition may be, and how the typical progression of a condition applies to the individual in question, case managers should

• consider medical guidance [LINKS TO A to Z list of common illnesses and conditions | NHS inform ; Health A to Z - NHS (www.nhs.uk) ; Scottish health information you can trust | NHS inform ]
• request a case discussion with a practitioner. Relevant life events The level of needs an individual has might change due to upcoming life events.

If, based on the information the case manager has on the individual, a future life event is expected to change the individual’s level of needs, the case manager should set a review for after that event. If it can be expected that the individual will require time to adjust to their new circumstances, following that event, the case manager should take this adjustment period into consideration.

For example, an 18-year old individual who has a learning disability or Autism may be looking to move into supported accommodation in the near future. Alternatively, they might be planning to live independently, which could change their level of needs.

Similarly, an individual who is receiving ongoing support for their learning disability or mental health will be moving from child services to adult services around their 18th birthday. This may change the level of care, support, or treatment they receive and therefore could change their ability to manage their condition