Specific review scenarios: No change in needs reported

An individual reports no change to their level of needs or conditions. This is in line with our expectations, as based on the information on their award, we were not expecting to see a change.

Example – No change in needs reported, as expected

Brian’s Adult Disability Payment (ADP) is due for review. On his submitted review form, he indicated that his needs remain unchanged. Brian has a diagnosis of autism and currently receives a standard award for both Daily Living and Mobility components.

The Case Manager pulls Brian’s scheduled review task from the SPM work queue and reviews all the case details, including previous decisions and Supporting Information (SI). Brian was diagnosed in childhood and has consistently received appropriate support from health professionals. Supporting Information has previously been provided, demonstrating his needs both at home and in the community.

The Case Manager determines that Brian remains entitled to the standard rate for both Daily Living and Mobility and as a change to his needs is unlikely in the near future, a review period of 5 years is set.

Example 2 – No change in needs reported, as expected

Paul’s Adult Disability Payment (ADP) is due for review.  On his submitted review form, he indicated that his needs remain unchanged.  Paul has a diagnosis of treatment resistant schizophrenia and currently receives a standard award for both Daily Living and Mobility components.

The Case Manager pulls Paul’s scheduled review task from the SPM work queue and reviews all the case details, including the previous decision and Supporting Information (SI).  Paul was diagnosed 7 years ago and, he continues to be prescribed antipsychotic medication.  The supporting information previously provided confirms that he has an ongoing need for support, and despite some established coping strategies his condition is unlikely to significantly improve. 

The Case Manager determines that Paul remains entitled to the standard rate for both Daily Living and Mobility and as a change  to his needs is unlikely in the near future, a review period of 5 years is set.

If the case manager decides that it is unlikely that the individual’s conditions or needs will change, they should set a long review period (between 5 and 10 years).

If the case manager decides that it is highly unlikely that the individual’s conditions or need will change, and the individual is entitled to the enhanced rate of the daily living and the mobility component, the case manager should consider giving an indefinite award.

An individual reports no change to their conditions or level of needs. This is not in line with our expectations, as based on the information on their award, we were expecting to see a change.

The case manager should both:

• treat this as an inconsistency
• proceed with exploring inconsistencies in information to establish whether the inconsistency is relevant.

This could, for example, involve checking guidance or requesting a case discussion. If the inconsistency is indeed relevant, they should choose from the set of options below to explore and resolve it:

• Contact the individual to ask follow-up questions. Here, case managers must ensure that this phone call does not become, or feel to the individual like, consultation, as consultations are carried out by practitioners only. For more details, see operational guidance on contacting individuals with follow-up questions
• Choose the decision-making tool that is most appropriate/ most likely to provide the information they need to make a robust decision.

There are a number of decision-making tools for case managers to use:

• Consulting guidance (DMG, Operational Guidance, Medical Guidance)
• Case discussion
• Requesting supporting information
• Consultation

Supporting information:

• is just one of several decision-making tools
• should not be the default step to take

when establishing the individual’s level of need.

Rather, the case manager should choose the action based on what’s most appropriate in the review at hand. As part of that, they should consider what’s best for the individual. For example, a quick phone call to ask a follow-up question might be better than the individual having to:

• collect supporting information from their wider support network
• wait a number of weeks until the case manager’s request for supporting information has been answered by the contact the individual has provided.

If the case manager decides that gathering supporting information is the most appropriate decision-making tool, they need to decide which source would be best-placed to provide the information they need. This can be a professional or a member of the individual’s wider support network.

Crucially, requesting supporting information should be done with the goal to more fully understand the individual’s new level of needs. The aim here is not to “verify” what the individual has told us.

Case managers should remember to follow the ‘collaborative information gathering’ where it is appropriate to gather supporting information at review. The individual might already have relevant supporting information at hand to help you make a determination meaning the Agency might not need to directly request it from a professional or the client’s support network. For more information, see the ‘Gathering Supporting Information’ chapter.

Example 1 – no change in needs reported, but a change was expected 

Sarah has rheumatoid arthritis and she currently has an award of enhanced Daily Living and enhanced Mobility. Sarah completed a no change declaration for her scheduled review.

The Case Manager pulls Sarah's scheduled review task from the SPM work queue. They familiarise themselves with the details of the case. Sarah was diagnosed with rheumatoid arthritis in her twenties and it is now widespread in her hands and feet, causing significant pain and limited mobility and movement.

At the time of her application, Sarah was due to begin new medication with the hope this would improve her symptoms.

Based on the information available, the case manager expected that Sarah’s needs might have improved due to treatment, the Case Manager decides more information is needed before making a robust determination.

They call Sarah, who explains that the medication hasn’t helped. Sarah provides a letter to indicate that she had trialled all available medications for her arthritis and none were found to help. Based on the condition and supporting information, the Case Manager is able to justify their decision that Sarah's needs are unlikely to have changed.

The case manager requests a case discussion with a practitioner to discuss whether Sarah would meet the criteria for an indefinite award.

The practitioner confirms that as Sarah’s condition is highly unlikely to improve. Given the absence of any further treatment options and the stability of her circumstances, the practitioner notes that an indefinite award would be appropriate for Sarah. 

The Case Manager determines that Sarah remains entitled to enhanced daily living and enhanced mobility, and an indefinite award is given.

Example 2 – No change in needs reported, but a change was expected

Jane’s Adult Disability Payment (ADP) is due for review.  On her review form, she completed the no change declaration to say that her needs haven’t changed.  Jane has a history of depression and was receiving distress brief intervention, and prescribed 50 mg of the antidepressant sertraline. She currently has an award for the standard rate for Daily Living and no award for mobility.

The Case Manager pulls Jane’s award review task from the SPM work queue.  They familiarise themselves with the case.  From the information available, they believe that due to Jane’s treatment/medication she would have been expected to improve.  Therefore, a change would have been expected.

The Case Manager considers this to be an inconsistency and decides further information is needed to make a robust determination.  They phone Jane who tells them distress brief intervention was not successful and her sertraline does has increased to 100mg. Jane provides supporting information from her GP, which confirms this. 

The Case Manager then requests a Case Discussion with a practitioner, to get a better understanding of Jane’s current needs and what an appropriate review period would be, given the complexities. 

Based on the information gathered, the Case Manager determines that Jane is still entitled to the standard rate of Daily Living and no award for mobility, as her condition has not improved and her needs remain unchanged.  They set a review period of 2 years, as more treatment is planned. 

Example 3 – no change in needs reported, but a change was expected

Maryam’s Adult Disability Payment (ADP) is due for review. On her review form, she completed the no change declaration to say that her needs haven’t changed. Maryam has a history of triple negative breast cancer and has been receiving chemotherapy and targeted immunotherapy. She currently gets the standard rate for Daily Living and no award for Mobility.

The Case Manager pulls Maryam’s award review task from the SPM work queue. They familiarise themselves with the case. From the information available, they believe that due to the client’s treatment/medication the client would have been expected to improve, therefore, a change would have been expected.

The Case Manager considered this to be inconsistent and decides further information is needed to make a robust determination. They phone  Maryam, who tells them treatment has not been as successful as they had hoped. Maryam’s triple negative breast cancer has required additional cycles of chemotherapy as the response has not gone as well as anticipated. Maryam has had side effects of peripheral neuropathy, nausea and vomiting as well as infections from immunosuppression that have meant reducing the dose and taking breaks from treatment.  Maryam uploads Supporting Information (SI). The SI states that Maryam has a further year of treatment to go, there is a plan for surgery for a mastectomy after the chemotherapy and then a course of radiotherapy.

They request a case discussion with a practitioner, to get a better understanding of Maryam’s current needs and what an appropriate review period would be given the complexities. 

Based on the information gathered, the Case Manager determines that Maryam’s condition has not improved and her needs have increased. They award Maryam enhanced daily living and enhanced mobility, and set a review period of 3 years as more treatment is planned.