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Specific conditions and indefinite awards
An individual must be entitled to the enhanced rate of the daily living and mobility component of Adult Disability Payment, to be considered for an indefinite award.
To make a decision about an indefinite award, you should consider all relevant factors outlined in this chapter [link to Relevant considerations for giving an indefinite award or setting a review period section] to build up a holistic picture of the individual’s circumstances and the likelihood of their needs changing over time.
When considering the individual’s condition as one of the factors, understanding whether their condition is fluctuating, progressive, relapsing and remitting, or permanent is helpful. Refer to the Condition section in this chapter for more information [Condition section further up in this chapter].
To further support your understanding of whether an indefinite award would be appropriate for a client, you should also consider the condition lists in this chapter.
If an individual has a condition listed in Pathway 1, this is likely to mean the individual has a stable level of needs and it is highly unlikely that the individual’s condition will improve. This suggests that setting a review period is inappropriate and that, unless other factors set out in this chapter clearly indicate a future change, an indefinite award is highly likely to be right for this person. For example, if a person whose condition is listed on Pathway 1 indicates that they will be moving into more accessible accommodation soon, this relevant life event is likely to impact on their level of needs. An indefinite award would not be appropriate until after this event has happened and they have fully adjusted to their new situation.
If an individual has a condition listed in Pathway 2, this is means that the individual potentially has a stable level of needs, but that it is possible that the individual’s condition may improve. This suggests that setting a review period may be inappropriate. Here, the condition isn’t as strong an indicator as in Pathway 1. You therefore will have to consider the other factors more closely to come to a decision.
These lists are non-exhaustive and are provided for reference purposes only.
If an individual has a condition or multiple conditions that do not appear on either list, you should nevertheless go on to consider whether the individual’s overall level of need is highly unlikely to improve: Conditions that might indicate a review is appropriate but additional factors suggest it might not]. This is called Pathway 3.
Conditions that suggest a review is inappropriate (Pathway 1)
Some conditions will generally not involve a change in the individual’s level of need. These conditions will usually be permanent or progressive.
If an individual’s condition features on the list below, and they are entitled to the enhanced rate of both ADP components, you should regard this as an indicator that an indefinite award might be appropriate. However, there is not automatic entitlement for an indefinite award based on certain conditions. This is because:
- individuals are impacted by their condition in different ways
- we make entitlement decisions based on a holistic consideration of the person’s circumstances
You therefore still have to consider all the other factors outlined in this chapter [Relevant considerations for setting a review period section] to understand whether any of them suggests that an indefinite award would not be appropriate for the individual in question.
Some individuals whose condition features on this list may be entitled to ADP under Special Rules for Terminal Illness (SRTI). If this is the case, refer to the Special Rules for Terminal Illness (SRTI) DMG chapter instead.
Be aware that this list is non-exhaustive and are provided for reference purposes only.
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Whilst the individual may have a condition that is listed, their application or supporting information may indicate that they are undergoing treatment or therapy that may change their level of need. In these circumstances, you should still consider the likelihood of a change based on the available information before deciding whether or not to set a review period.
Example: an individual’s severe needs are highly unlikely to change
James is 64. He was diagnosed with Parkinson’s disease 10 years ago. When applying for ADP about 2 years ago, he reported having stage 3 Parkinson’s which was causing some unsteadiness, poor balance and some motor symptoms. He noted that whilst he had some difficulties with mobilising and daily activities, he was still able to live independently with some aids for assistance. Since his initial determination, James has been in receipt of standard rate for both daily living and the mobility components of ADP.
James submits a Change of Circumstances form in which he details a deterioration in his Parkinson’s disease. He reports that his mobility has worsened significantly and he now requires a walking frame. He is struggling to use the aids he once relied on due to poor coordination and grip and his brother has moved in with him as he was no longer managing independently in his home. James notes that outwith attending appointments, he is no longer able to mobilise outside of his home due to stiffness and falls.
At his most recent specialist review, he was told this had progressed to stage 4 Parkinson’s. James’ doctor has increased his medication but James is experiencing significant side effects such as swallowing problems and dyskinesia as a result.
James adds that he finds his memory and ability to think clearly have been impacted and his doctor confirmed that cognitive changes are common in the later stages of Parkinson’s disease.
The case manager reviews the information James has provided and determines that James is now entitled to the enhanced rate for both daily living and mobility components of ADP. The case manager considers the progressive nature of James’ Parkinson’s disease and that James’ symptoms and restrictions are highly unlikely to improve. They determine that an indefinite award is appropriate.
Conditions that suggest a review may be inappropriate (Pathway 2)
Some conditions will potentially not involve a change in the individual’s level of need, but for some individuals this may not be the case.
Some individuals whose condition features on this list may be entitled to ADP under Special Rules for Terminal Illness (SRTI). If this is the case, refer to the Special Rules for Terminal Illness (SRTI) DMG chapter instead. [LINK]
If an individual’s condition features on this list, and they are entitled to the enhanced rate of both ADP components, you should regard this as an indicator that an indefinite award may potentially be appropriate. However, there is not automatic entitlement for an indefinite award based on certain conditions. This is because:
- individuals are impacted by their condition in different ways
- we make entitlement decisions based on a holistic consideration of the person’s circumstances
You therefore still have to consider all the other factors outlined in this chapter [ Relevant considerations for setting a review period section] to understand whether any of them suggests that an indefinite award would be appropriate for the individual in question.
Be aware that this list is non-exhaustive and are provided for reference purposes only.
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Example: a lifelong condition that may have changing levels of need
Kellie has a diagnosis of schizophrenia. This condition was first diagnosed age 22. Kellie is 24 years old and lives with her family who support her on a daily basis.
Schizophrenia is a mental health condition that can lead to lifelong impacts for many people, however successful treatment and support can reduce the impact on daily life.
On Kellie’s application form, she notes she requires prompting, support and assistance for activities 1, 2, 3, 4, 6, 9, and 10. The following points were awarded:
1(e): 4 points
2(d): 4 points
3(b): 1 point
4(c): 2 points
6(c): 2 points
9(c): 4 points
10(b): 2 points
For the mobility activities Kellie reports that she is able to go out on her own. The supporting information indicates that on the majority of days she needs to be accompanied as she would not be able to safely undertake journeys alone due to acting on pervasive thoughts that attract hostile attention. She reported no difficulty with walking. The following points were awarded
1(f): 12 points
Kellie also mentions that she has been trialling medication for the past two years and has seen some positive effects.
As Kellie is entitled to the enhanced rate of both ADP components, the case manager considers whether an indefinite award might be appropriate for Kellie. They know that schizophrenia is a lifelong condition with low probability of full remission and are aware that it is listed on Pathway 2. They therefore carefully consider the other factors outlined in this chapter to determine whether or not to set a review period.
They establish that there is indication of Kellie responding to treatment, so there is a possibility that she will experience a change in her overall level of need.
As Kellie has been undergoing treatment for only two years and is responding well to treatment, the case manager decides that an indefinite award is not appropriate. The case manager decides that a five year review is appropriate, as treatment may improve Kellie’s condition within the medium term. Kellie might be eligible for an indefinite award in the future, if her needs don’t improve and remain stable, despite her medication.
Conditions that might indicate a review is appropriate but additional factors suggest it might not (Pathway 3)
Some conditions might ordinarily suggest that a review of the individual’s entitlement to ADP is appropriate. These conditions will not normally be identified as part of Pathway 1 or Pathway 2.
However, sometimes the other factors outlined in this chapter, when taken together, can suggest a review would be inappropriate. In that case you should consider making an indefinite award.
Example: an individual is eligible for an indefinite award due to the combined impact of their conditions on their life
Blair is 48 and works part-time as a volunteer for a charity but mostly from home. Blair completed an application for ADP where they report a primary generalised osteoarthritis condition, that they have had for the last 20 years.
This has been complicated by a diagnosis of obesity. They have been in receipt of surgical interventions, physiotherapy, occupational therapy, take multiple pain relieving medication, all of which has had minimal effect. In their application form Blair reports restrictions in activities 1, 2, 3, 4, 5 and 6 of the daily living component.
The case manager awards the following points for the daily living component:
1(e): 4 points
2(b): 2 points
3(b): 1 point
4(d): 2 points
5(b): 2 points
6(d): 2 points
Blair also has a diagnosis of anxiety disorder that does not significantly impact upon their level of need.
For activity 12 they report that due to pain and breathlessness, caused by osteoarthritis and obesity they are unable to walk more than 20 meters.
The case manager awards the following points for the mobility component:
2(e): 12 points
Blair is entitled to the enhanced rate of both the daily living and the mobility component. From the information Blair has provided, the case manager understands that Blair’s needs, stemming from the overall impact of his conditions, are highly unlikely to change. The case manager therefore thinks that an indefinite award might be right for Blair.
They request a case discussion to discuss not setting a review period. During the case discussion, the practitioner confirms that Blair is experiencing a number of severe conditions that affect their ability to complete activities. It is clear that there is not likely to be a significant improvement in their condition. The complex effect of all of their conditions limits their ability to either lose weight or improve mobility, whilst symptom management is likely but there is limited chance of a substantial improvement.
The case manager decides that it is reasonable to make an indefinite award and passes on their determination to a senior staff member for QA.