Independent Review of Adult Disability Payment (ADP): Analysis of responses to a public consultation and call for evidence

7. Decision-making

This chapter analyses responses to questions about of Social Security Scotland’s decision-making process for awarding Adult Disability Payment. Social Security Scotland provides both clients and case managers with guidance for consideration of environmental, cultural and social factors. This is to ensure consistency and fairness during the decision-making process.

In contrast to Personal Independence Payment, Social Security Scotland requires one piece of supporting information from a formal source, such as a social care assessment, medical report, or prescription list. Social Security Scotland uses consultations with a Social Security Scotland practitioner to help gather more information about the application and assist practitioners in the decision-making process. Consultations can take place over the phone, by video call, at a local public venue or in the person’s home. A person is only invited to take part in a consultation when there is no other practical way to understand their needs and only covers the areas of the application that Social Security Scotland needs more information about.

Key findings

• Three fifths (60%) of consultation respondents felt the Adult Disability Payment decision-making process is effective in understanding a person’s daily living needs, with comments outlining positive experiences. However, 17% found it ‘not very effective’ and 24% ‘not effective at all’. Reasons for this included that the decision would benefit from a more qualitative and individually focused application form which more effectively captures details about a person’s condition and lived experience. Others felt that their supporting information was ignored in the consideration of their application.
• Among the small number of respondents who had a consultation as part of the decision-making process, most had them on the telephone, and respondents typically indicated that the consultation happened at a time convenient for them. Few provided qualitative feedback about the consultations. Those who did said that they felt the case manager was polite and clear in their intent. Suggested improvement provided by a few respondents included greater clarity that the consultation could be held in a way that best suits the person applying.
• Four fifths (80%) of those who had received a decision understood it. In open comments however, some described confusion about their award and the points they received, often reflecting disagreement with the decision. This was also reflected in the call for evidence, where respondents highlighted instances where decisions appeared to be inconsistent with supporting information.
• Better communication about decision-making was a key theme in both consultation and call for evidence responses. This included calls for clearer communication about how points had been allocated and decisions made, and information being delivered in a method that best suits the client, such as large font format.

Consultation

Q14A. How effective do you think Social Security Scotland’s decision-making process is with regards to understanding a person’s daily living needs?

Q14B. Please give reasons for your answer.

Mixed views were evident among those answering Q14A. While three fifths (60%) felt the decision-making process is effective in understanding a person’s daily living needs, 35% felt the process is ‘somewhat effective’, with 7% indicating they find it ‘very effective’. Conversely, 17% found it ‘not very effective’ and 24% ‘not at all effective’.

Ineffective: more qualitative, person-focussed experience needed

Just over two thirds of consultation respondents commented at this question. The most common theme was that a more qualitative and individually focused application form would improve the effectiveness of capturing a person’s daily living needs. Some felt the application form did not capture the details about their condition and their lived experiences. This included neurodiverse and people with non-physical conditions or disabilities. A few suggested that the form was too rigid, not allowing clients to explain specific aspects of their daily living that are different from the areas highlighted in the application.

“It is impossible to share the full range of information required to provide a comprehensive understanding of someone’s daily living needs. As such the decision will always be subjective.” – Individual

Others thought that consultations or calls with case managers, where case managers could ask for clarification and where clients could explain their daily living in detail, may have helped capture their lived reality more effectively. In contrast, a few others who spoke to a case manager felt their information was not captured accurately and suggested better staff training would make the process more effective.

Effective: positive experience with services

In contrast, several respondents felt that the decision-making process was effective. Respondents explained that they found the award letters clear and comprehensive in including all the information provided by the client. They also noted higher levels of trust in the Adult Disability Payment process compared to Personal Independence Payment and felt the process was more respectful.

“The award letter explained perfectly why I received points for each section and although it was really upsetting and quite shocking to read that back about myself and realise the seriousness of my conditions, I felt that they did it with understanding, compassion and most importantly respect. Something I never received from PIP. I actually cried reading my PIP letter and felt sick to my stomach. My ADP letter, although hard to read those things about myself, they said nothing derogatory or discriminatory about me.” - Individual

Ineffective: further information was ignored

Some respondents suggested that supporting information was ignored in the consideration of their application. In some cases, the supporting information was provided directly by the client and in other cases, the client felt that their health care professionals were never contacted by Social Security Scotland to gather supporting information.

Q15A. Have you received a decision on an application for Adult Disability Payment?

Overall, 69% of those who answered indicated they had received a decision about their application. One quarter (27%) had not and 4% were unsure.

Q15B. If you said “yes”, were you invited to take part in a consultation as part of applying for Adult Disability Payment?

While Q15B was intended for those who answered ‘yes’ at Q15A, a larger number of respondents left a response. Respondents who had not received a decision may have answered as they had not (yet) been invited to a consultation. Among those who answered Q15B, one in ten (10%) indicated they have been invited for a consultation; three quarters (76%) had not and 14% were unsure.

Q15C. How did the consultation take place?

Among the small number of respondents who had been invited to a consultation and answered Q15C, most (88%) had a telephone consultation.

Q15D. Did the consultation take place at a convenient date and time for you?

Among the small number of respondents who had been invited to a consultation and answered Q15D, three quarters (75%) indicated it was convenient for them.

Q15E. What worked well about the consultation process?

Q15F. What worked less well about the consultation process?

Fewer than one in ten respondents provided a comment to Q15E and Q15F.

What worked well

The most prevalent theme was that clients found practitioners helpful and consultations less stressful than expected. Two respondents noted that the people they spoke with, whether that was case managers clarifying application points or healthcare professionals undertaking a consultation, were kind. One individual noted that they appreciated the lack of medical assessments, and another felt the phone call they had was efficient.

“The lady was very polite, explained fully why she was calling and didn't keep me for too long. She only asked one question, and it wasn't intimidating or anxiety inducing.” - Individual

One respondent mentioned that they appreciated the flexible consultation format, and another found that speaking to a person was helpful.

What worked less well

A small number of individuals noted that they did not like telephone consultations. One noted they were unaware at the time that they would have been able to have a consultation in another way. Another found it difficult to explain and remember details when discussing their condition over the telephone. Another did not like the consultation as they felt it was painful to go back over their daily living information.

“I am autistic and find telephone calls very distressing, I was not given another option or aware I could request this.” - Individual

Other comments about consultations

At Q15J, which asks about changes to the decision-making process, a small number of respondents requested that consultation be used more often to avoid re-determinations or appeals. They expressed a view that issues which impacted their award outcomes could have been avoided if they had been queried in the first place. Two others also suggested improving the consultation process by ensuring the clients felt listened to and respected.

While event participants were asked about consultations, few participants or those they supported had experienced a consultation with Social Security Scotland staff as part of the decision-making process. The difference between Personal Independence Payment and Adult Disability Payment was highlighted in one event, where it was felt that Social Security Scotland case managers were helpfully trying to make a decision without a consultation where possible. In the same event the professional backgrounds and level of medical knowledge of the consultation practitioners was queried, and Social Security Scotland was urged not to subcontract this activity to local councils.

Organisational representatives at one event requested being kept up to date with data around consultations, such as why people were invited to a consultation, how many are being conducted, and how many clients had support from an advice agency about consultations. They felt this would be beneficial in knowing what information had been omitted in the original application, improving the application advice they give to clients, and potentially reducing Social Security Scotland staff’s workload by reducing the need for consultations further.

Q15G. Did you understand the decision?

Four fifths (80%) of those answering understood the decision they had received, 13% did not and 7% were unsure. The number of respondents answering this question was lower than the number who indicated they had received a decision, but this may reflect confusion about whether the question was asking about the decision or the consultation.

Q15H. Did you need support to understand the decision?

Q15I. Please explain your answer.

Reflecting levels of understanding, four fifths (81%) of those who answered did not need support understanding the decision. However, one in ten (12%) did.

Confusion about the decision

Just under a quarter of consultation respondents commented at Q15I. The most prevalent theme in response to this question was confusion about why the client received the points they were awarded, often reflecting disagreement with the decision. While some did not explain further how they needed support to understand the decision, others had used family members or advocates to understand how the award was decided. One respondent, for example, saw that their GP was unaware of the impact of their condition upon their life and therefore did not provide sufficient supporting information. Another highlighted their confusion about their award.

“I didn't know why I scored 5 points previously for depression, then with depression and ADHD I scored zero.” - Individual

Positive comments

Some provided positive comments about the clarity of communication around their award. Others said they understood the decision letter because it was jargon-free, did not include legal language, and was very detailed.

“The decision responses were clear and concise. Using evidence submitted via present and past (both consultations and previous awards). The decision took into account my disabilities and how they would affect me on a daily basis. I feel the reviewer understood the information I submitted and was fair in their decision.” – Individual

Q15J. What could have been changed about telling you what the decision was? What do you think the impact of that change might be?

Better communication

Almost one third of consultation respondents provided a response to Q15J. The most prevalent theme in responses was for improvements to communication to help clients clearly understand the decision. This included a desire for more feedback on the application, with respondents feeling that the letter was too short and did not include personalised or specific information about their case. Improving the personalisation of the communication in the award letter was also highlighted at stakeholder events. Another recommended clarifying the language by using declarative statements, and this was reiterated at almost all engagement events. Another suggested that phone calls could be used alongside or in lieu of award letters to help clients better understand the decision.

Some of these challenges were highlighted in mixed views expressed in engagement events. There was a call for a summary sheet with the decision and key points on one page to improve clarity, as well for providing clear reasons for the decision to help support organisations explain the reasons for the decision to applicants they are supporting. However, participants at another event felt that the decision letter is clear, with the first page explaining the decision and breaking down the points and descriptors. This was contrasted to Universal Credit, where no explanation of the rationale for decisions is given, and Social Security Scotland were praised for supporting people’s understanding of how the decision has been made and providing information should a re-determination be needed.

In an interview with a stakeholder, the RNIB noted that details about required communication formats were not passed over from DWP to Social Security Scotland during the transition, which meant that some received decision communication in an inaccessible format.

“I need font size 40, this was recorded on my files with DWP, but this information wasn’t shared with Social Security Scotland when I transferred onto ADP from PIP. It would be helpful if this type of information was shared between the agencies dealing with my benefits.” - RNIB

One respondent noted that they received their first payment before they received official notification of their award, which they found confusing. This was also reflected in engagement events where participants spoke of instances where they were worried about their award and, while starting to receive the payment was good, it did not help ease their concerns about the process.

Timescales

Some respondents noted that the timescales for decision-making were too long. The processing times for Adult Disability Payment are explored in more detail in Chapter 10.

Call for Evidence

Q8. Thinking about when a decision on an Adult Disability Payment application is made, do you have any evidence about how clearly the reasons for the decision are explained to the person?

Clearer communication needed

Just over half of call for evidence respondents answered Q8. The most prevalent theme in responses was that communication about how decisions are reached needs to improve and be more transparent. Respondents noted this for a range of reasons. Often, respondents suggested that award letters are not clear enough in explaining why points have been awarded or not awarded.

Others suggested that, from their perspective as advocates or welfare specialists who see several award letters, they can identify different types of inconsistencies in decisions. For some, the reasons behind individual decisions seem inconsistent, while others notice inconsistencies across client experiences. These respondents felt that the wording of the decision as well as the reasons behind decisions lack consistency.

“When discussing reasons for appealing with appellants we often find that they are unclear on why certain points were not awarded based on their conditions or limitations, also the reasons can be inconsistent. For example, if points are awarded for difficulty in the bathroom with standing but not carried over into the kitchen when preparing a meal people are unclear as why this is so when it is the same difficulty. The decision does not explain the difference in its reasoning.” – Glasgow City Council

“The reasons for the decision are clear, however, they are also inconsistent. We are aware of decisions made with regards to some claimants with similar circumstances can vary. With the inconsistent decision-making it leads to further additional workload through appeal processes.” – Epilepsy Scotland

A few organisations requested that more information about the points and descriptors be provided to clients with their awards letter to clarify exactly what was awarded and why.

Decision inconsistent with supporting information

A small number of respondents highlighted that while the reasons for the decision were clear, they did not align with the information provided in the application.

“We have had mixed feedback from people with MS in relation to how decisions have been explained to people. In response to a recent survey that the MS society conducted 14 out of 28 (50%) respondents in Scotland said they didn’t think that the report they received gave an accurate reflection of their MS … There was further evidence of these inaccuracies on people’s decisions among the people we have spoken to in preparation for this response.” - MS Society Scotland

Participants at a few events also advocated for greater transparency around the decision-making process. This included being provided with more information about how points have been allocated, what case managers are basing their decisions on, the professional background of case managers and their level of training and medical knowledge, how much they consult Social Security Scotland medical personnel to inform decisions, the weighting given to different types of supporting information and if the decisions are peer-reviewed.

However, at a few events Adult Disability Payment decision-making was described as an improvement on that of Personal Independence Payment. It was described as less adversarial, and it was welcomed that Adult Disability Payment is paid while a re-determination is being considered and that Adult Disability Payment seems to place more weight on supporting information from families, GPs and support workers.