The balance of probabilities

All determinations are made on the balance of probabilities. This means that if something is more likely than not, it’s considered a fact for the purposes of decision-making.

We’re not looking to be satisfied that any information is true ‘beyond reasonable doubt’ – that is a higher degree of certainty used in criminal justice decision making.

When considering any information, we start from a position of trust. Where information conflicts, and this inconsistency is relevant, you should consider the value of each piece of information and decide which is more likely to be accurate.

Making decisions on the balance of probabilities

You must establish the facts of a case on the balance of probabilities for:

• every decision that forms part of a determination of entitlement
• the determination of entitlement

You must consider all the relevant information you have when making decisions on the balance of probabilities.

If you have to consider contradictory information, you must decide which account is more likely than not to be accurate.

We always start from a position of trust. Trust in what the individual has told us should be the baseline assumption during the decision-making process. However, this trust is not absolute. If there are details which suggest that information is more likely than not to be untrue, you should explore these inconsistencies and may decide that the information is not an accurate reflection of the facts. There could also be information from the individual which is so inaccurate it suggests it may be intentionally misleading. See ‘enabling people to access assistance’ for what to do in these circumstances.

Similarly, the balance of probabilities does not mean that the individual must be given the benefit of the doubt if there is not enough information to establish the facts of the case. In this case, you would need more information.

Decisions which are straightforward

In some cases making decisions on the balance of probabilities will feel easy. This could be because:

• there is a lot of available information
• the pieces of information are consistent with one another
• the individual’s circumstances are very straightforward

For example, you could have a case where an individual:

• has severe depression that impacts on their care needs throughout the day
• sets out in their application that they require frequent prompting at every mealtime to eat and get help to wash and dress due to struggling with their energy levels
• details that their symptoms impact their ability to communicate independently, meaning they require frequent support, including through someone speaking on their behalf and encouraging/prompting them to speak
• is taking medication that has known side effects that can impact appetite and energy levels
• sets out that they do not have any night-time needs

As the information provided is more closely related to attention with bodily functions rather than continual supervision, and the individual does not have night-time needs, you would be able to answer the question ‘is it more likely than not that this individual requires frequent attention throughout the day in connection with their bodily functions’ easily in order to make a determination in alignment with the decision making guidance that the individual is entitled to the lower rate of PADP through satisfying the daytime condition.

Decisions which are complex

In some cases making entitlement decisions on the balance of probabilities will be more difficult. This could be because:

• some information is missing
• there are inconsistencies
• the individual’s circumstances are very complex

If this is the case, you’ll need to establish on the balance of probabilities which information is more likely to be true in order to:

• resolve relevant inconsistencies
• close existing gaps that are relevant to establishing the individual’s entitlement

To do this, you’ll need to:

• carefully establish value between the information available
• use your judgement.

If more information is needed

In some cases, you may need more information to make a decision on the balance of probabilities. This could be because:

• there are relevant gaps in the information
• there are relevant inconsistencies in the information
• the individual’s circumstances are very complex

By relevant we mean that if the information that is the source of the inconsistency was taken as fact, it would impact the individual’s entitlement. For example, exploring the gap or inconsistency would enable a decision as to whether the individual satisfies the:

• daytime condition, or whether their needs are not significant enough to be entitled to PADP (i.e. entitlement to lower rate PADP v no entitlement)
• daytime condition, where you have already established that they satisfy the night-time condition (i.e. entitlement to higher rate PADP v entitlement to lower rate PADP)
• night-time condition, where you have already established that they satisfy the daytime condition (i.e. entitlement to higher rate PADP v entitlement to lower rate PADP).

All other gaps and small inconsistencies are unlikely to be relevant and do not need to be explored. For example, you have established the facts that an individual requires assistance to wash and dress themselves, as well as support with toileting and eating. The individual requires support with most areas of their daily needs due to their disability, including support to sit upright in the bath, dressing their lower half and with getting to and from the toilet. They often need additional bathing and change of clothing due to having accidents. The individual also receives support with cutting their food and regular prompting to eat at every mealtime.

There is some indication in the information they have provided that they might need assistance with communicating with others, but this is too vague for you to understand whether that’s indeed the case. This gap is not relevant, as the individual needing or not needing assistance to communicate would not change their level of entitlement. This is because they already satisfy the daytime condition due to their needs regarding washing and dressing.

If the existing gaps and inconsistencies are relevant, you must explore them by using one or more decision-making tools. This could include contacting the individual, where appropriate,or their representative with follow-up questions.

If the information needed cannot be gathered, you must use whatever information is available to make a decision based on the balance of probabilities whether the individual meets the eligibility criteria for the care component. If there is not enough information to conclude that the individual has any needs that relate to the criteria, you should make the decision that they don’t meet the relevant criterion.

If you are unsure whether you have enough information to make that decision, you should request a case discussion or speak to your team leader.

Related reading

• Decision-making tools
• Making robust decisions – example section
• Supporting Information chapter
• Understanding and Interpreting Information