Decision-making tools

Decision-making tools can help you reach a fair and robust determination of entitlement.

Before deciding

• whether decision-making tool(s) are needed to help you make the correct determination
• which decision-making tool(s) is the most likely to provide you with the information you need

you need to familiarise yourself with the case at hand.

Case familiarisation

Case familiarisation is mandatory and should be completed at the beginning of each decision-making process.

It helps you to identify and understand relevant information that has been provided, such as:

• the application or review form
• available supporting information
• information from previous determinations made in relation to the individual’s entitlement, where applicable

Case familiarisation also helps you to understand if you need more information about the individual’s needs. Note that where it has not been provided you will only need to gather or request confirmation from a professional in some cases. Refer to the Supporting Information chapter and the Relevant Considerations chapter for guidance.

To gather all the relevant facts and make the correct determination, you may have to:

• use several decision-making tools
• return to a tool that you have used earlier in the process

Additional supporting information should only be requested from the individual if it would not be possible to make a determination without it.

The decision-making tools available to you are:

• Decision-Making Guidance
• contacting the individual or their representative with follow-up questions
• case discussions
• medical guidance
• consultations
• colleague support
• supporting information

There is no hierarchy in importance between decision-making tools. You need to determine on a case-by-case basis which one or several of these tools is best. To make this decision, you need to consider the following:

• which tool is most likely to provide you with the information you need to make a determination of entitlement
   
• is the tool in question appropriate? For example, if the individual has told us they do not want to receive phone calls, you should not phone them with follow-up questions. Similarly, consultations should only be used if other decision-making tools have not rendered the information you need.
   
• will the use of the tool significantly delay the decision-making process? For example, requesting additional supporting information might add another few weeks to the time it takes to process someone’s application.

Decision-making guidance

The decision-making guidance (DMG) interprets and explains our policy. It is our single source of truth when it comes to policy and its interpretation. It sets out the principles you should follow to make decisions. Reviewing relevant chapters of the Decision-Making Guidance is essential during the decision-making process.

You can see an overview of the different Decision-Making Guidance chapters for ADP on IKM.

The decision-making guidance is a living document which is updated regularly. You therefore should use IKM to access this guidance. You can save IKM pages in your Favourites in your browser.

You should never save versions of the decision-making guidance locally or create your own guidance. This is because over time local versions would diverge from the most up-to-date version of the decision-making guidance and could lead to wrong decisions.

If you discover gaps, inconsistencies, or errors in the decision-making guidance, you can use the feedback function on IKM to make sure these issues are being addressed. You can find the feedback form on the right-hand side on the landing page for the ADP Decision-Making Guidance. Alternatively, you find the feedback function by scrolling to the bottom of the individual chapter pages.

Contacting the individual or their representative with follow-up questions

The information provided in the following might be unclear or insufficient to make a determination:

• supporting information
• the application or review form

In this instance, you can contact the client by telephone to ask follow-up questions on the information they have provided.

When speaking to the individual to ask follow-up questions, you must make sure that your conversation does not become a de-facto consultation. Unless requested by the individual themselves, they have to receive an invitation to a consultation. Consultations can only be carried out by health and social care practitioners employed by Social Security Scotland.

You should be aware that supporting information is not written by the individual, but either by:

• a professional
• someone from their wider support network

The individual might not be able to provide answers on supporting information, particularly if we’ve gathered it on their behalf. In these instances, it might be best for you to contact the information provider with follow-up questions, if possible.

Case discussion

You can request clinical-based advice during a case discussion with a practitioner if you’re:

• unsure of how to progress a case
• unable to make a determination

For policy or legal advice, you can request a ‘case query’, which is a case discussion with our Decision Support Team. If necessary, they will liaise with Scottish Government policy or legal colleagues for advice.

Medical guidance

You can use medical guidance to help you understand:

• the impact a health condition or disability might have on the individual’s needs
• typical symptoms or prognosis of a health condition
• the impact treatment might have on the individual’s needs

We use the following sources of medical guidance:

• A to Z list of common illnesses and conditions | NHS inform ;
• Health A to Z - NHS (www.nhs.uk)(link is external) ;
• Scottish health information you can trust | NHS inform

The operational guidance provides more information on when and how you can seek:

• medical guidance
• advice from practitioners

Colleague support

Colleague support can come from your line manager or other team leaders. You should use this tool to discuss and share knowledge around processes and systems.

For example, you could use it to find out whether, in general, supporting information provided by professionals based outside Scotland is accepted by us.

Colleague support is an informal decision-making tool. You cannot use it to justify a determination or decision.

For example, you could not use it to ask a decision team leader for their view on information provided by the individual. This applies to all information in an application or review form and supporting information.

Consultations

A consultation involves a discussion between one of our practitioners and the individual about their conditions, disability, or needs. These should only be carried out if either

• you have tried other decision-making tools before, without success
• it’s the only practicable way to obtain information needed to make a decision, taking into account the individual’s circumstances
• you have been unable to establish good cause for the individual not having confirmation from a professional

A consultation should only be used after a case discussion.

Consultation reports can be used as confirmation from a professional, if the individual has not been able to provide confirmation.

Additional supporting information

Additional supporting information can come from a professional or the individual’s wider support network.

Requesting additional supporting information should not be used as the default decision-making tool. Rather, it should only be used if you’ve established that it is the most appropriate tool in the scenario at hand.

If the individual has provided additional supporting information with their application or review form, you must consider it during the decision-making process, even if the application or review form provides enough detail to make a determination.