Considering the value of information
Although you need to consider all information provided to support an application or review, you must identify what information will help you understand an individual’s care needs so you can make a determination about their entitlement to assistance.
This includes whether the supporting information provided is helpful. However, you should not expect:
- to need supporting information for every application
- that the value of that information will be the same in every case.
The last bullet is also applicable to all information provided in support of an application or review. Where in one instance, a statement of support acts as an important piece of information in determining an individual’s care needs, in another instance, the application may be more valuable than the statement of support.
This is because:
- the value and detail of the information available will differ from client to client
- what information is useful is dependent on the individual’s condition, needs and circumstances.
Therefore, you should not expect the same pieces of information from every individual, even where they share the same or similar condition/s.
Additionally, it is not possible to be prescriptive about the minimum requirements for a piece of information to be considered valuable, because it will depend on the specific circumstances.
You should consider the factors outlined in this section when deciding:
- how valuable a piece of information is
- whether more information is needed to make a robust decision i.e. if the information you have is not valuable or it doesn’t provide the necessary information needed to make a decision
Factors to consider
When deciding whether information is valuable you should consider:
- who it’s from (for information provided by someone who is not the client)
- the period of time it relates to
- the content
When considering the information, you should:
- Consider all the information you have within context
- Use other decision-making tools if you are unsure how to interpret it, e.g. a case discussion
Who the information is from
For supporting information, including the statement of support, you should consider if the source:
- knows the individual and understands the impact their condition or disability has on their life
- offers insight into the individual’s condition or disability as a result of their role in the individual’s life
- is involved in the individual’s treatment or care regularly
You should be satisfied that the provider of information can be reasonably expected to have an insight into the individual’s life. There is no definitive list of the nature of the way in which someone providing supporting information should know the individual.
For example, it is reasonable to assume that an applicant’s employer has a good level of understanding about how the individual’s conditions impact them at work. But if you know that the individual has been retired for 18 months, you’re likely to view the information as less valuable. This is because the individual’s care needs may have changed from when the employer last saw the individual 18 months ago.
This is because how regularly someone sees the individual may impact how valuable all the information is. This does not mean that the source has to see the individual or the impacts of their condition at a given regularity to be considered valuable. Rather that you should consider whether it is more likely than not that the source of information will be able to offer insights into the individual’s condition or disability based on how often they see, or when they last saw, the individual.
This will differ from case to case. It should also be considered in regard to whether the individual’s care needs are likely to have changed in the time since the source saw them, or if their condition remains fairly consistent.
You should request a case discussion if you are unsure about the individual’s current care needs in comparison to the date of the information.
There may alternatively be details in the information itself which de-value the perspective of the person providing it. For example, it may be clear that the person has simply observed from afar, rather than being directly involved in the individual’s life.
For supporting information from a professional, where provided, you should ensure that the source meets the requirements of a professional. You should use the Operational Guidance and the Supporting Information Chapter to help you identify a professional.
For information provided in the application form by the individual or person acting on their behalf, not including the statement of support, you should continue to take a trust-based approach to what they tell us about their condition. This is because the individual will know themselves and their condition best. For more guidance on taking a trust-based approach see the Supporting Information chapter and Principles of Decision Making chapter.
The period of time the information relates to
How up to date a piece of supporting information needs to be in order to be considered valuable will differ from case to case.
This applies to all information provided in support of an application or review, all supporting information including the statement of support, and any information gathered throughout the process i.e. follow up calls.
Identifying the date the information relates to can be done by:
- checking the date on any documentation submitted (i.e. the date printed on a prescription)
- noting where information mentions dates or time periods (i.e. a statement of support from the individual’s daughter may explain that they went to the GP with them 2 months ago where they were discussing their condition)
This list is not exhaustive.
The key consideration is whether or not the information is relevant to the period the application relates to. That does not necessarily mean the information needs to be recent. However, you must be able to make a reasonable assumption that it is relevant to the circumstances existing at the time the application relates to.
The main factors influencing how close in time the information needs to be to the application is the nature of the individual’s disability or health condition.
Individuals who have a disability or condition which is likely to remain consistent in the way it impacts them may have supporting information which is still relevant after many years.
Only if an individual’s condition is likely to have changed in a way that may have a significant impact on their care needs since the date of the information, might there be a reason to consider obtaining more recent information. This may be especially the case for individuals who have become newly disabled following a significant illness or injury, such as having had a stroke or having a limb amputated following a major trauma. In these instances, it’s probable that the individual’s care needs in the year immediately after the event might change to a greater or lesser extent after that point.
To support your understanding of the individuals needs between the differing dates, you may require the help of other decision-making tools such as case discussions and reviewing other decision-making guidance such as the Rates and Criteria Chapter.
Additionally, by significant changes in needs, we mean care needs that would prevent or allow an individual to meet either or both the daytime and night-time condition.
You do not need to take any further action where the difference in care needs expected between the date of the supporting information and the date of application does not change an individual’s level of entitlement.
This is because the criteria for PADP require you to take a broad view regarding an individual’s eligibility to either or both of these conditions, and they either meet the criteria or they do not. This means that an individual’s needs can change to require more or less support and still meet the same criteria.
For older individuals, it’s a reasonable assumption that once an individual has reached around retirement age, it’s unlikely that the impact certain conditions have on their care needs will become any less. For example, while you might require more recent supporting information for a 27 year old individual who had a serious pelvis fracture at 20, it’s likely that the needs of an individual who had the same injury at 57 will be at least the same at 70.
When deciding whether dated information is still relevant, you should consider the individual’s current needs and decide whether it is more likely than not that their needs have changed in a way that might impact their entitlement since the date of the information.
It is the identified date of the information that is the factor to be considered here, not the content in regards to the information on their care needs.
You may conclude that the information was dated from a time relevant to the application or review but the information it provides is inconsistent with other information you have gathered, In this case, the information is relevant but there is an inconsistency.
If you’re unsure if the information is current enough to help you, you should use other decision making tools, such as medical guidance or requesting a case discussion.
Where you determine that a piece of information is not relevant, or is less relevant, to the period the application relates to, you are not automatically required to get a ‘replacement’ piece of information. This includes gathering an alternative confirmation from a professional. To help you determine if you need an alternative source of supporting information, you should refer to the decision tree in the Supporting Information chapter.
As always with PADP applications, you should be mindful of the individual’s personal circumstances and whether this has any impact on their ability to provide up-to-date supporting information.
You should refer to the guidance in the Supporting Information Decision-Making Guidance to determine your next steps where both apply:
- you decide a piece of supporting information is not valuable
- you think this will impact your ability to make a decision
Example when confirmation from a professional is dated more than a few years old but may still be valuable
An individual with a diagnosis of a long-term chronic disability or condition, such as osteoporosis, may have supporting information from ten years ago that acts as a confirmation from a professional, and can also be used to establish care needs.
The case manager should use this supporting information to support them in making a determination if it is clear that there is likely to be no change in that individual’s care needs in the period since the supporting information was produced.
Example when supporting information more than a few years old may not still be valuable
A case manager may receive additional supporting information from a professional about an individual who has a diagnosis of a physical health condition, such as relapsing remitting multiple sclerosis, from five years ago.
However, as the particular condition can have a fluctuating impact, this piece of supporting information may not be useful in coming to a decision on an individual’s level of entitlement to PADP.
This is because the supporting information may no longer reflect the individual’s current care needs. In this case, further information about the individual’s current care needs might be sought.
The information could however be used as confirmation from a professional because although the specific way in which the client is impacted may have changed, the fact that they have a diagnosis at all will not have changed.
The content of the information When thinking about the value of information provided by the individual, consider if the information:
- relates to the individual’s experience of their condition rather than general information about that condition
- provides the information needed in order to understand the individual’s care needs
- is broadly consistent with what you would expect for an individual with their condition/s
- is broadly consistent with any other information provided in support of their application or review i.e. supporting information, or if there is a reasonable explanation for any inconsistencies.
When thinking about value of supporting information, consider if the information:
- includes additional detail not provided on the application or review form
- relates to the individual’s experience of their condition rather than general information about that condition
- is broadly consistent with the information in the application or review form, or there is a reasonable explanation for any inconsistencies.
Make sure you fully understand any specialist language or terminology used. This is so you can correctly interpret the information.
If you need to check what something means, use other decision-making tools such as medical guidance or a case discussion.
Do not treat supporting information from abroad any differently. If you need to request translations, see accessibility guidance.
The supporting information provides additional information
You may conclude that a piece of supporting information is valuable if it contains additional details not provided in the application or review form.
You should not automatically disregard additional information that is relevant if it is inconsistent with other information. You should consider whether there is a reasonable explanation for the inconsistency. If there is no reasonable explanation, you should follow the guidance on inconsistencies in this chapter.
The information relates to the individual’s experience of their condition
Information is valuable where it is an account of how the condition impacts the individual on a day-to-day basis or provides details on their care needs.
Information provided with an application may offer lots of additional detail about the condition in general. For example, information from a factsheet, a leaflet or a medical website. However, this is not necessarily valuable as it does not necessarily give you any insight into how that condition impacts the individual or their care needs.
For supporting information, the same piece of information is valuable whether the source has seen what they are reporting for themselves, or it is something they have been told.
Where supporting information indicates that what they are reporting is not something they have seen themselves but is something the individual has told them, you should not treat this information any differently.
This could result in individuals who do not have supporting information contacts who regularly see their day-to-day needs being disadvantaged.
Medical professionals are unlikely to see the individual at any great length when they do see the individual. There are also some aspects of an individual’s care that it is unreasonable to expect certain professionals to see for themselves, such as nighttime toilet needs.
As a result, their insights on certain care needs may only come from what the individual has told them.
Example: Considering different pieces of supporting information based on their value
Lisa is 66 and applies for PADP with diagnosis of fibromyalgia. Lisa’s application does not provide a lot of detail on the impacts of her condition on her life. However, alongside her application, she asks Social Security Scotland to collect supporting information from her GP and from her sister. As the case manager does not have enough information from Lisa’s application to make a decision, and the application contained significant inconsistencies, they progress to contacting Lisa’s GP and sister.
The GP returns the Supporting Information Request Form confirming her diagnosis and medications and provides a summary of her symptoms. However, they also advise that they did not consider her to have significant fatigue because Lisa was able to attend the surgery recently.
The case manager also collects supporting information from Lisa’s sister. Lisa’s sister submits a letter detailing the effects of activity on Lisa. She explains that although Lisa is able to do small amounts of activity, she would not be able to leave her bed for the next couple of days as a result. She advises that Lisa has also had a recent assessment by a local authority Occupational Therapist for aids and adaptations to the house. She was assessed as needing a shower chair, grab rails at various points in the house, a perch stool, and a walking frame with inbuilt seat because of variability in her ability to walk.
The case manager notices that the needs described by Lisa’s sister are significantly higher than what is suggested by the symptoms in the GP’s supporting information. The case manager decides these are inconsistencies between supporting information and that they must assess their value. Therefore, the case manager establishes that:
- although the GP is likely to have had a lot of experience with Lisa, they should not automatically assume that this piece of supporting information is more accurate or valuable than the other letter
- the letter from the GP confirms Lisa’s conditions and provides information on her symptoms at the time of the appointment
- the appointment was 8 months ago and was Lisa’s first time at the GP surgery in several months
- Lisa's sister looks after her 3 times a week and has done so for 2.5 years. In the letter she describes how Lisa’s symptoms have worsened over the last 6 months. She describes how Lisa is impacted by her conditions every day, and that she needs increased support when dressing, washing and moving around indoors.
The case manager concludes that the supporting information from a professional does indeed confirm Lisa’s conditions. However, they conclude that on the balance of probabilities the care needs stated in Lisa’s application form and by Lisa’s sister are more likely to be true than not true because:
- Lisa knows her condition best and her sister is more familiar with Lisa’s day to-day needs than the GP.
However, as the case manager is unfamiliar with Lisa’s condition and due to the inconsistency, they request a case discussion with a Practitioner. They do this so they can further understand the expected symptoms and care needs associated with fibromyalgia. The case discussion confirms that:
- The care needs described are reasonable and consistent with her diagnosed condition and treatment
The case manager proceeds to make a determination based on:
- the information provided on the application form
- the confirmation of Lisa’s conditions by the GP
- the sister’s letter describing Lisa’s every-day needs
- the case discussion with a Practitioner providing additional insight into the condition
Related reading
- What is supporting information
- Principles of decision-making
- Our approach to supporting information
- Supporting information operational guidance
Differences in describing levels of need
Some sources of supporting information will have a point of reference that impacts how they describe an individual’s care needs.
Their perspective will be impacted by:
- the way in which people they regularly come into contact with are impacted by their condition
- the nature of the conditions the people they see often have
- the prognoses they are used to discussing
You should consider the source and the context when reviewing supporting information.
For example, a GP might describe an individual’s condition as ‘well-controlled’. They might choose that term because they know their condition has the potential to be very difficult to treat with medication and could routinely become very severe.
A condition being well-controlled does not necessarily mean that the individual will not have any daytime or night-time needs. It may simply mean that the way they are impacted by their condition is consistent. The GP may use ‘well-controlled’ to indicate a range of circumstances, including that the individual:
- is prescribed treatment for their condition and consistently takes it as directed
- has a condition which does not impact on them currently
- has a condition which is stable and consistently impacts them in the same way
It is important to remember that all subjective terms, such as mild, stable, well behaved, easily managed etc require a judgement to be made by the person using them. They should not be seen as definitive and the wider context in which they are made must be considered.