Ongoing, current or planned treatment or surgery

If the information available on the individual suggests that they are either:

• currently undergoing
• likely to soon undergo

a planned course of treatment or surgery that is expected to improve their overall condition or level of care needs, you 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 either

• a scheduled review would be necessary after
• an indefinite award might be appropriate despite an upcoming course of treatment or a planned surgery, you 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. You 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 treatment, e.g. a surgery, is completed. This should include time for any recovery or adjustment to, e.g., new medication. 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.

Individuals’ ability to fully recover from treatment will vary, e.g. due to their age or complications during the treatment. For example, there will be a significant difference between the recovery an individual will make after having a hip replacement when they are 66 and 86 years old. One might be expected to recover reasonably well, while the other is at higher risk of post-operative complications and might never fully recover.

If you need guidance on likely recovery times, you should use medical guidance or 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 older adult who is newly diagnosed with Rheumatoid Arthritis may have just begun their first trials of medication, and have yet to receive any support/aids to allow them to manage their symptoms. Based on their condition and information on the medication, it can be expected that they may require further Rheumatology reviews and medication changes to find a medication that works well for them, and to learn how best to manage their symptoms. This includes, for example, treatment for inflammation and Analgesia for pain management, such as Methotrexate, Co codamol, and Ibuprofen, as well as establishing an appropriate dosage. Here, a shorter review period may be reasonable.

In contrast, an individual with Rheumatoid Arthritis who;

• has a well established treatment plan (medication and pain management)
• has suitable aids and support (to manage if/when symptoms worsen) may have more stable needs. Here, a longer review period may be appropriate.

If an individual with multiple conditions has a surgery scheduled or treatment planned which addresses one or several of their conditions, an indefinite award may still be appropriate if their overall level of need will not be affected by this treatment in a way that would impact on their entitlement.

Alternatively, it may be that the individual has tried a number of treatments which have not lessened the impact of their condition. This would again suggest that an indefinite award is appropriate.

In other cases, the condition may be affected by a planned course of treatment or surgery, or may change in impact as the individual adapts to it. In this case it is less clear that the individual will not experience any changes.