Gathering supporting information

Confirmation from a professional

The confirmation from a professional should broadly confirm the individual’s conditions, disabilities or needs. It can only come from professionals.

For example, the confirmation may provide details on:

a diagnosis, where an individual has been diagnosed
a treatment being received, such as medication or physiotherapy
steps taken to find out about the individual’s condition and make a diagnosis
aids and equipment that an individual uses to manage daily life
an individual’s needs where they do not have a diagnosis

It is not required for every review and you should refer to the Relevant considerations when making a determination as part of an award review (determination without application) guidance to decide whether it is required.

You may determine that a confirmation from a professional is required but may be unable to gather it. You should consider whether you can establish good cause where this is the case.

Refer to the Good cause section to read about what qualifies as good cause in the context of Scottish Adult DLA.

The role of a confirmation from a professional

The confirmation from a professional only needs to broadly confirm the individual’s conditions, disabilities or needs.

It is not necessary for this piece of supporting information to confirm:

every detail the individual has outlined in their form
every condition or disability they might have
the severity of the disability or condition, or the level of needs the individual’s formal diagnosis

The confirmation might also provide additional details on the impact the condition or disability has on the individual’s day-to-day life. You should not expect this. This level of detail would be expected from additional supporting information.

If the confirmation from a professional that is available contains additional details, you must not disregard these but should consider them separately when establishing the individual’s entitlement and needs.

Lack of confirmation from a professional

If confirmation from a professional has not been provided with the review, you must decide whether either

confirmation from a professional should be requested
good cause can be established

Refer to the Relevant considerations when making a determination as part of an award review (determination without application) guidance to guide your next steps.

There are many reasons an individual may not be able to provide confirmation from a professional.

Good cause

Good cause is the term for a reasonable explanation as to why a confirmation from a professional is not available or is delayed on a review, where you have determined that it is required.

Establishing ‘good cause’ allows you to make a positive determination despite not having confirmation from a professional (where required). It refers to there being a reasonable explanation as to why the individual has not provided this supporting information.

Where there is a lack of a confirmation from a professional, you should always consider if there is good cause before requesting or gathering a confirmation from a professional.

Good cause for not having a confirmation from a professional when requested

Reasonable explanations might relate to:

lack of access to or contact with professionals
their health or disabilities
a hospital stay
being placed in local authority care or legal detention
lack of support needed from an advocate or support worker, including in relation to filling out the application or review form
dealing with an unexpected life event, like a death in the family
having difficult lives due to their disabilities or conditions
how their condition/s are managed i.e. when older people are in receipt of services, they may be more likely to receive input from multiple care providers and there can be a lack of any one professional who has the oversight necessary to provide the confirmation from a professional
the level of input by professionals i.e., their condition is managed by their family and wider support network with minimal professional input. This has historically been the case with learning difficulties and disabilities, and mental health conditions.
Unresponsiveness to, or lack of engagement with, supporting information requests.

This list is not exhaustive.

Good cause due to unsuccessful supporting information requests

Good cause for supporting information being unavailable does not just apply to the individual’s personal circumstances. It also applies where you do not receive a response from a professional to your, or the individual’s, supporting information request, or where this response does not contain any information of value (for example, they do not answer the questions in the form),

Where a professional:

is unresponsive to a supporting information request
responds declining to answer your questions
provides a response that is of low value
does not provide information relevant to the individual or the application (e.g. sending a leaflet on a condition, rather than confirming that the individual has the condition or how they are impacted by the condition).

you can establish good cause for why you did not receive the confirmation from a professional you requested.

Lack of confirmation from a professional when it is requested and no good cause

This is scenario is where you:

determined that a confirmation from a professional was needed to make a robust determination
were unsuccessful in gathering the confirmation from a professional
could not establish a reasonable explanation, such as a professional being unresponsive, as to why a confirmation from a professional was not available.

Where this is likely the case, before you establish whether or not there is good cause, you should ensure that the individual understands

what confirmation from a professional is
how to find and submit it
that we can gather it on their behalf.

If confirmation from a professional still doesn’t become available after this engagement, you should go on to make a negative determination.

After you have established good cause

If you have established good cause, you should move on to establishing the individual’s level of need and their entitlement. You should use the information you have available to you to do so, such as the information provided by the individual in their review form.

Requirements of the professional

The following information applies to both:

professionals providing the confirmation from a professional and
professionals who provide additional supporting information.

To provide supporting information, the professional or organisation providing the confirmation from a professional should fall into one of the following categories:

have been involved in the individual’s care, treatment, or everyday life for a period that would allow them to be familiar with their needs
have carried out an assessment of the individual’s condition, disability or needs
have the professional knowledge and access to records to provide an informed opinion on the individual’s condition, disability or needs

Professionals from the same organisation can provide supporting information, even if they have not been directly involved in that individual’s treatment or care.

They must have both:

access to records on the individual
the professional knowledge needed to understand these records

You do not need to obtain additional permission from the individual where the named contact at an organisation is not who will respond to the supporting information request.

For example, the GP who normally sees the individual and has been named on their application or review form might not be available. In this case it’s acceptable for a different GP from the same surgery to fill in the supporting information request form.

This is because they have access to the individual’s medical record. It would not be acceptable for a member of staff who does not have medical training, such as a receptionist, to fill in the form.

Examples of who could provide this

This could include:

social workers
psychologists
health professionals, such as nurses, GPs or consultants
allied health professionals, such as physiotherapists, speech and language therapists, or occupational therapists
local authority staff, an assessment of need, or an individual’s care plan (such as homecare staff)
health boards, such as Fife Health Board or Lothian Health Board
paid support workers who can confirm the level of care an individual receives
third sector, private and other organisations or individuals who provide professional support to the individual

This list is applicable to professionals who work in both the public and private sector. For example, a private physio or a health care professional working for the NHS. As long as they are familiar with the individual, their condition, disability or needs in a professional capacity, professionals from the private sector can provide supporting information.

The same rules apply to professionals from the private sector as they do for professionals in the public sector in relation to who from that organisation can provide the supporting information. I.e. Another professional from the same organisation can provide supporting information provided they have the expertise to understand the individual’s condition and records. For example, another doctor at the same practice but not the receptionist.

Practitioners are not considered a professional for supporting information purposes. They cannot provide either the confirmation from a professional or additional supporting information from a professional.

Examples of supporting information from a professional

This could include:

occupational health report
treatment plans
diagnosis
appointment or referral letter
social work report
a list of medications prescribed to the individual
care assessments or a care plan
medical specialist report
information documenting the physical supports put in place by a local authority, such as a stair lift, ramp or accessible shower
supporting information request form
guardianship reports (not letters confirming guardianship). You should consider a case discussion if you are unfamiliar with the guardianship process or do not understand relevant sections of the report.

Deciding whether a source is from a professional

The following guidance in this section is only applicable to the confirmation from a professional.

Deciding whether a source is a professional is important when deciding whether a document can be counted as a confirmation from a professional.

To help make a decision on this, you should use the information presented in this section as well as the pages on:

Confirmation from a professional
Additional supporting information

If the definitions already provided are not enough to make a decision, you should consider if the provider of the source:

is being paid to provide a service to the individual
is qualified or trained to provide their role to the individual
has a personal relationship with the individual beyond their organisational role
is acting within a formal capacity
has specific skills or training to be able to provide support the individual
has provided clear professional documentation, for example is it on letter headed paper
can be found by their details or credentials on official registers or systems, such as the Scottish Social Services Council, the General Medical Council, the Nursing and Midwifery Council or another professional regulatory body
is still working in their field, for example they’re currently practising, not retired

This list is not exhaustive.

You should consider the answer to these questions and make a decision on a case by-case basis. You should also consider the examples below.

If you conclude that it is more likely than not that a piece of supporting information is not from a professional, you should consider both:

if you need to collect an alternative source as the confirmation from a professional, including how you work with the individual to source this information if needed.
if the information can be used as additional supporting information

You may conclude that a source is not from a professional but does contain information regarding the individual’s disability, condition or needs relevant to the application.

You should still consider this information as part of your decision-making. The information would count as additional supporting information. It would still count as this type of supporting information regardless of it was from a professional or the client’s wider support network.

If you want advice on how to classify a source of the confirmation from a professional, you can:

speak to your line manager
request a case discussion

A volunteer who runs a social club in the local church on Sunday afternoons and regularly supports an individual belongs to the individual’s wider support network. Information they provide would be considered additional supporting information

A volunteer runs a social club in their local community centre and is a retired social worker. They recognise the individual’s difficulties in most social interactions and have practised strategies with them that help the individual to avoid becoming overwhelmed easily.

However, this volunteer would not be considered a professional.

This is because the capacity in which they would be considered a professional would be through their status as a retired social worker. However, as they are retired, they no longer have the credentials to act in this capacity and are not active in their field.

Their testimony is still an important source of additional supporting information from the individual’s wider support network, but case managers should seek an alternative document as confirmation from a professional, if it is needed to make a robust determination.

Confirmation from a professional that has gaps and inconsistencies

In their confirmation, professionals may provide information that is (partially) inconsistent with what the individual has told us on their review form. These inconsistencies can relate to:

the broad confirmation of the conditions, disability or needs
the severity of the needs the individual has told us about.

Inconsistencies relating to the confirmation of conditions, disability or needs

The confirmation from a professional might, for example:

not mention one or multiple conditions the individual has told us about.
Explicitly state that the individual does not have the condition they have told us about

The confirmation does not mention all conditions, disabilities or needs

Confirmation from a professional, where needed:

does not have to confirm all conditions, disabilities and needs the individual has told us about. However, sometimes this can be an inconsistency that is relevant and needs exploring.
should confirm a condition that is related to the individual’s needs and these must be relevant to the Scottish Adult DLA eligibility criteria.

Relevant considerations when a confirmation does not mention all conditions, disabilities or needs might be as follows:

Whether it is reasonable to assume that, on the balance of probabilities, it is more likely than not that the professional should have known about all the individual’s conditions
You should consider whether the confirmation from a professional is a pre existing document, such as a referral letter. Here, it would be reasonable to expect that it will not mention all of the client’s conditions. In order to find out whether an additional confirmation from a professional might still be required, read the next section.

In some cases, however, it would be reasonable to expect that the confirmation from a professional mention all conditions the individual has detailed in their application form. For example, if one of the individual’s conditions is a known condition which is highly likely to coexist with the other condition the individual has told us about and the professional treating the individual only confirms one of the conditions, this would be a relevant inconsistency. This inconsistency would need to be explored, irrespective of whether the document confirms a significant portion of the needs mentioned in the review form. You should consider consulting medical guidance or utilising a case discussion to help you establish known conditions that are likely to coexist. This list is not exhaustive. If you decide that an inconsistency is relevant and needs to be explored, you should follow the existing guidance on gaps and inconsistencies, including potentially needing further supporting information.

When an additional confirmation from a professional may be required

The following guidance applies only where you have determined that a confirmation from a professional is required. In this scenario, an additional confirmation refers to where, at review stage, you have:

Determined a confirmation from a professional is required
Requested and received a confirmation from a professional
Concerns that this confirmation from a professional may not be relevant to the review and that you will need an alternative confirmation to the one already requested at review stage.

Where both

The needs the individual has as a result of the condition that is confirmed by a professional do not impact the individual’s entitlement (i.e. they have not reported a change in these needs or this confirmed condition)
the needs the individual has as a result of the unconfirmed condition/s would impact their entitlement for Scottish Adult DLA

it would generally be reasonable for you to expect the individual to provide confirmation of the condition that would change their entitlement to Scottish Adult DLA.

You should refer to the Relevant considerations when making a determination as part of an award review (determination without application) guidance for more information on when a confirmation from a professional should be requested.

If you conclude that the what the provided confirmation from a professional confirms is

not relevant to changes reported by the individual

you should follow the guidance the lack of a confirmation from a professional section of this chapter. Although you have concluded that another confirmation from a professional is needed to confirm the change in needs, the guidance regarding good cause still applies. You can determine that another confirmation from a professional is needed and still establish good cause.

Establishing when:

an existing confirmation from a professional is not relevant and
another confirmation from a professional is needed

will differ from case to case. You should use your judgment to make this decision. If you struggle to understand whether an existing confirmation from a professional is acceptable, request a case discussion.

To establish whether you’ll need additional confirmation from a professional, you should:

consider whether out with the confirmation they have already provided, they would have a reasonable explanation for not providing another confirmation and you can establish good cause
use the balance of probabilities when considering whether what condition/s or need/s have been confirmed can reasonably be expected to cause any needs relevant to the review
consider involving a health and social care practitioner to understand the needs associated with a given disability or condition

The confirmation explicitly denies what the individual has told us about their conditions, disability or needs

In some instances, the professional you reached out to for confirmation of the individual’s conditions, disability or needs might directly deny that the individual has a certain condition, disability or need. This is different from instances where the confirmation from a professional simply does not mention one or multiple conditions or needs the individual told us about.

Taking a trust based approach, you should establish whether this inconsistency needs to be explored or whether there is a reasonable explanation for it. For example, the professional might wrongly assume that the individual does not have a condition, because they have not seen the individual since that new condition developed.

Additionally, where individuals are reporting new conditions that have not been diagnosed, the professional may give an accurate response stating the individual does not have the reported condition despite being aware of their needs. In this case, even though the professional has denied the existence of the condition, this does not necessarily constitute a denial of these needs or symptoms. You should remember that an individual does not always need a diagnosis in order to be eligible for our benefits, it is their level of needs that is being considered.

You should not automatically assume that the individual is dishonest and does not have that stated condition or need – it might be reasonable to assume that the professional was unaware of all of the individual’s conditions and/or needs.

If you establish that the inconsistency needs exploring, you should proceed to do so as you would with any other piece of supporting information, including applying equal consideration to the confirmation and the review form and requesting a case discussion, if needed.

If you can resolve the inconsistency (i.e. there is a reasonable explanation for why the confirmation does not broadly confirm what the individual told us in their review form), you should move on to establishing the individuals needs and entitlement.

You may be unable to resolve the inconsistency (i.e. there is not a reasonable explanation for why the confirmation does not broadly confirm what the individual told us in their review form).

You should discuss the case with your line manager. If they agree with your assessment that the inconsistency cannot be resolved, you should not make changes to the individual’s entitlement based on the inconsistent information.

Inconsistencies relating to the severity of needs

The confirmation from a professional might state that the individual’s needs are

higher or lower than or
of a different nature from

needs described elsewhere in the individual’s review.

Consider whether this inconsistency is worth exploring. In order to determine this, you should, for example, consider whether the inconsistency would impact on the individual’s level of entitlement. For example, if

the individual has reported a severe level of care needs but
a professional describes the needs to be much lighter than that, but still significant enough for the individual’s award to increase

this inconsistency would not impact on their level of entitlement and would not need to be explored further.

If you establish that the inconsistency needs exploring, you should proceed to do so as you would with any other piece of supporting information.

Part of Scottish Adult Disability Living Allowance decision making guide