Understanding and interpreting information – including supporting information

Inconsistencies and gaps in information

When you look at the information provided with an application or review form, there may be gaps or inconsistencies between them. Not all gaps and inconsistencies need to be explored.

In this chapter, we use the term ‘relevant inconsistency’ to refer to inconsistencies that are identified after you have established good cause or gathered a confirmation from a professional. You should only be identifying relevant inconsistencies when you are the point in your decision making of determining an individual’s needs and entitlement.

A relevant gap or inconsistency is one that:

needs to be resolved in order for you to determine the individual’s level of needs and entitlement
does not affect whether you need a confirmation from a professional
will impact the individual’s level of award if it’s not resolved

Byan ‘inconsistency’ in this chapter, we are referring to information that is not consistent with each other. This could be information that is directly contradictory but can also be information that is inconsistent in regard to severity of needs or impacts.

This is not the same as a ‘significant inconsistency’ as is explained in the Supporting Information chapter, where an inconsistency refers to information regarding an individual’s needs that is not expected i.e. the needs reported are more or less than would be expected for that individual with that condition and their circumstances

The purpose of this chapter is not to help you identify where a confirmation from a professional may be required but rather to help you resolve inconsistencies through other decision-making tools, such as additional supporting information.

A gap or inconsistency is not relevant if the missing information would be helpful to have but is not necessary for making an accurate decision and establishing the facts of the case.

If you cannot make a decision without resolving the relevant gap or inconsistency, you should use decision making tools.

For example, an individual may explain on their application that they require help from their partner to get dressed on some days. Their partner provides additional supporting information and explains they help them get dressed every day. The two pieces of information are inconsistent with each other but are not direct conflicts. The partner confirms they help them get dressed, but there is an inconsistency in regard to how often they help them.

Inconsistencies can occur:

within a piece of information
between pieces of supporting information
between supporting information and the application or review form

By a gap, we are referring to missing information specifically relating to an individual’s care needs and the impact of their condition. Gaps do not refer to a lack of a confirmation from a professional. You should refer to Supporting Information for guidance on what to do where there is no confirmation from a professional. The size and significance of a gap will vary, and gaps should be expected. This is because conditions can be life-long and complex and it can be difficult for any one source to include all of the details on these, including the application form.

Whether a gap needs to be filled is dependent on its significance. The significance of a gap is dependent on your ability to determine entitlement. If you are unable to make an entitlement decision without filling the gap, you should use decision-making tools to help fill the gap. This includes gathering additional supporting information to establish entitlement only where other decision-making tools have not helped, or you are able to determine that they will not provide the information you need.

Before attempting to fill a gap or explore an inconsistency, you should consider whether:

it can be resolved or accepted without taking any action
it is significant enough to need exploring
the piece of information containing the gap or inconsistency is valuable and would merit having the inconsistency explored

When deciding whether a gap or inconsistency can be resolved or accepted without taking any action, consider all of the following:

individuals may under-report their needs, especially if they have more than one condition or where they are sharing sensitive information such as toilet needs
conditions can be life-long and complex making describing them difficult for some clients
whether an individual’s condition could impact their ability to describe their condition (i.e. if they were recently hospitalised, whether their condition impacts cognitive function)
unanswered questions, or answers that don’t offer helpful insights, may not mean that the individual has no care needs in that area. Individuals and sources of supporting information may leave out useful information because they’re not used to the questions on our forms.
the view of a professional may be conclusive of their opinion but is not automatically conclusive in establishing an individual’s condition or care needs. Context and point of reference are vital
the source of the supporting information may be from someone who doesn’t know the full extent of the individual’s needs, and this can explain an inconsistency
supporting information does not need to support every declared need, especially if the individual has complex needs and/or several conditions

If you do decide to explore a gap or inconsistency, you must:

remain aware of your unconscious bias and ensure you approach the gap or inconsistency from a neutral position. You should not assume the outcome of the gap or inconsistency until you have explored it
make decisions based on the balance of probabilities, as always, making use of other decision-making tools where needed.

Exploring inconsistencies

You should consider the following points when you explore an inconsistency between pieces of information. You should continue to remember that all information must be given equal consideration.

If the individual’s own information has conflicting details, clarify this directly with the individual where possible.

The value of the information

At what point in the process you choose to explore an inconsistency will differ from case-to-case and depend on:

whether there is a reasonable explanation for the inconsistency
if the information containing the inconsistency is valuable
the complexity of the inconsistency

Whether you establish the value of a piece of information before exploring an inconsistency is at your discretion.

In some cases, you will need to have considered the value of a piece of information before deciding if an inconsistency need exploring. This will likely be in scenarios where the inconsistency is complex or not easily resolved.

This can help ensure that you are exploring an inconsistency for information you have concluded is valuable.

Where the information containing the inconsistency is of little value, you should consider if there are any benefits to exploring the inconsistency.

However, for other inconsistencies, you may decide that the process for resolving it would be quick. In these circumstances, it is reasonable to explore the inconsistency before you have robustly considered the value of the information.

Other decision-making tools

You should consider what decision-making tools would best help you resolve an inconsistency. This includes continuing to use the balance of probabilities throughout the decision-making process to establish whether the care needs are likely to exist, given the information you have.

By best, we mean the outcome of an inconsistency being resolved robustly in a time efficient manner. This means you will need to balance how well a decision-making tool would help you to resolve an inconsistency with how long that same tool would take to help you resolve the same inconsistency.

For example, an inconsistency may exist between what a GP has submitted and what the individual’s wider support network describes the individual’s needs as. You may decide that the best way to resolve this definitively would be to request further supporting information from the GP. However, you also know that the GP took a long time to respond to initial supporting information request and so you are unlikely to get a quick response on your new request. You should consider if other decision making tools, such as a case discussion, would provide similar results in regard to helping you resolve the inconsistency. This approach balances the quality of information with the time it takes to establish that information.

Gathering supporting information should not be your default decision-making tool. Supporting information is one of a suite of decision-making tools you can use to help you make decision. It is also often the decision-making tool that will take the longest time to provide you with the information you need.

Before gathering further supporting information, you should always consider whether the inconsistency can be resolved through a follow-up call to the individual, where appropriate, or a case discussion. You should also ensure you have read the guidance:

in this chapter on supporting information after an application
in the Supporting Information Decision Making chapter

Supporting information after an application

Where needed, supporting information can be submitted or collected after an application. This supporting information:

should be considered in the same way as information given with the application
does not have to support every detail in the application or review form

To help you determine if supporting information is needed, you should refer to the decision tree in the Supporting Information chapter in the first instance.

Only request additional supporting information after an application if all of these apply:

it’s essential to your decision-making i.e., you are unable to make a decision on whether an individual is more likely than not to meet the criteria for PADP
the individual has given their consent for you to do so
no other decision making tools have provided the information you need
you do not have a reason to believe the information does not exist. For example, if you have established good cause because the individual has told you they do not have supporting information and they do not know of anyone who could provide it
you have followed the guidance the Supporting Information chapter decision tree and the outcome is that you need to gather supporting information.

Involving a practitioner

Involving a practitioner is recommended when:

you have identified inconsistencies and need the expertise of a practitioner to help you explore them
you do not have enough information, including supporting information, to make a decision

Ian is 72 and has submitted a PADP application. He states that he has had depression and anxiety for the past five years which already indicates to the case manager that he has significant care needs in the day. Alongside his application he provides a prescription list dated from the previous month as supporting information. It details which medication he is prescribed and at what dosage. These are:

200 mg of Sertraline per day
15 mg of Mirtazapine per day
Propranolol up to three times a day when necessary

As the case manager does not have the medical training needed to interpret what these prescriptions mean in relation to Ian’s needs, they request a case discussion with a practitioner. The practitioner confirms that:

these medications are consistent with someone diagnosed with depression and anxiety
an individual prescribed these medications at the stated doses is likely to have a higher level of care needs. They would also expect the applicant to have the support of other professionals, such as psychiatry.

The case manager considers this information alongside Ian’s application and notices there are inconsistencies in the care needs stated by Ian in his application. Ian reports that he can manage the majority of activities independently. However, he later explains that he is reviewed regularly by psychiatry for suicidal thoughts and is supported by a community psychiatric nurse.

Ian’s descriptions of his needs are inconsistent with the level of medication he is prescribed and the support he received. The case manager, after considering the information provided by Ian and the practitioner, that they should explore these inconsistencies. This is because they are unable to determine his level of care needs. The case manager:

phones Ian to clarify how much support he needs and how they support him.

After the call, the case manager is satisfied that:

Ian had underreported his needs and that he had described his ‘better days’, of which he only has one or two a week
Ian requires more support than he stated on his application for the majority of his time. He sees both the psychiatric nurse and the community psychiatric nurse regularly.

Although Ian did not directly explain his care needs on his application, through:

their conversation with Ian
the knowledge of the input he has from a psychiatric and community psychiatric nurse
the medication he takes and at what doses

the case manager is able to determine that it is reasonable to expect Ian to have care needs that would make him eligible for PADP. This includes needing support to manage his condition and medications – support he receives from the input of the community psychiatric nurse.

The case manager is now able to make a robust determination based on this clarification.

Part of Pension Age Disability Payment decision making guide