National Implementation Group on Terminal Illness meeting minutes: 1 November 2022

Attendees and apologies

Attendees

• Dr Linda de Caestecker
• Dr Jenny Bennison
• Teresa Cannavina 
• Lisa Cresswell
• Gordon Dawson 
• Nathan Gale
• Richard Gass
• Margaret Grigor
• Paul Knight
• Ryan Laurenson
• Jo McKay
• Shonagh Martin 
• Dr Mini Mishra
• Kirsty Reid
• Chris Shepstone
• Natalie Stewart
• Flora Watson
• Susan Webster

Apologies

• Alexander Close
• Pat Carragher
• Rod Finan
• Kirsty Maciver
• Richard Meade
• Claire Pullar
• Donna O’Boyle
• Ellie Wagstaff

Items and actions

Welcome and introductions 

The Chair welcomed members to the 12th meeting of the National Implementation Group on Terminal Illness (NIG). 

Update on actions from last meeting

The minutes from the previous meeting were agreed and formally approved by the group.

Officials updated on the actions from the previous meeting: 

Action point 1: Officials to review wording on application form to ensure it does not suggest that a GP should be the main contact.

• officials updated that, after the previous meeting of the National Implementation Group, they made an update to the application form for terminally ill people allowing them to elect more than one clinician meaning Social Security Scotland have multiple contacts for a client. This update was shared with Social Security Scotland staff and this change is being monitored to ensure its success  

Action point 2: Update by officials from Social Security Scotland on the research into the reasons for the low use of the digital application challenge.

• officials will provide an update on this at the next meeting as no research has been undertaken on this so far  

Officials provided further updates on ongoing developments as follows. 

Officials updated on the issues around consent between applicants, GPs, and Social Security Scotland that was discussed at a previous meeting. 

Practitioners have reported difficulties obtaining BASRiS information in some instances as a minority of clinicians are reluctant to share this information due to concerns around consent. This relates to both the clinician having consent from their patient to share their information and to Social Security Scotland having consent to obtain that information. Social Security Scotland practitioners are advising clinicians that the client has given explicit consent to the Agency for them to contact them, however this is does not always resolve the situation. 

This issue has affected around 5% of cases so far and while this is a relatively small proportion the delays this can cause to a client’s award being paid can be significant. Officials confirmed that they are improving communications around this issue, including producing a Frequently Asked Questions document for clinicians. Officials asked members for insight into this issue and their thoughts on anything which could be done to improve things. 

Members shared that they had received feedback from GPs expressing their concerns about having to provide the information in duplicate - over the phone and again on the form. It was suggested that instead of a phone call, an email could be sent with an URL asking clinicians to complete the form. Members also suggested sending an email to practices first so that GPs are prepared for the phone call and have a form of confirmation of the practitioner’s identity. Officials noted the issues with using email including the risk that an email address is incorrect and personal details are sent to the wrong person, and Social Security Scotland’s ability to manage mailboxes.

Members suggested adding a line to the form confirming that consent is not necessary as the client has nominated the person being contacted, however Officials confirmed there is already information on this included on the form. 

Officials shared that unfortunately a client had died before they received their payments due to delays getting the BASRiS information. Members suggested sharing this story with clinicians to raise awareness among them.  

Members also suggested working with Local Delivery leads who can provide support and reassurance within practices. Primary Care colleagues, Senior Clinical leaders and Medical Directors should also be made aware of the issues. 

Officials told members of one situation where they have been unable to engage with anyone in the General Practice. Dr Mishra agreed to speak with clinical colleagues on this particular case if Social Security Scotland colleagues require her to do so.  

Action point 1: Officials to update on action point 2 above.

Action point 2: Gordon Dawson to liaise with Dr Mishra on specific case raised. 

Update on Child Disability Payment (CDP) and Adult Disability Payment (ADP)

Officials gave an update on the most recent statistics for CDP. 

There are 50 Special Rules for Terminal Illness (SRTI) cases currently in payment. 22 of these have come through the SRTI route, 16 through the standard application route, 7 through case transfer and 5 through alternative routes.

4 applications have been received through the SRTI route that were switched to the standard application route. Officials have been working to make improvements that will reduce the number of applications being received through the SRTI route incorrectly, including creating a dedicated section on mygov.scot that clearly outlines what SRTI means and who should apply through this route. Officials have also been working with Social Security Scotland colleagues and amended guidance so that client advisors are clear on how to define terminal illness and can respond to other questions on SRTI. These changes have improved the process and the volume of applications being received through the wrong route has dropped, however the issue has not been completely resolved. 

Members suggested targeting information at GPs through in practice Welfare Advisors. It was noted that not all General Practices have a Welfare Advisor, however it would be possible to reach most Welfare Advisors through two or three communication routes. 

Officials also flagged concerns raised by some third sector organisations. When a BASRiS or DS1500 form is sent to DWP, the case transfer process should automatically be triggered. However, there have been some cases where this hasn’t happened, and Scottish Government officials are working with DWP to find out why this is. 

Officials gave an update on statistics for Adult Disability Payment. Since launch, the SRTI team have processed 1163 cases. 613 have been confirmed as SRTI cases and paid. 431 cases have been confirmed as non-SRTI. 

Update on BASRiS forms for Universal Credit/Employment and Support Allowance

Officials gave an update on the discussions with DWP to agree a process for clients in Scotland who apply for Universal Credit (UC) or Employment and Support Allowance (ESA), and Scottish disability assistance. 

Some clients will have to submit both a BASRiS form and an SR1 form (the new form for UC and ESA replacing the DS1500). If DWP receive a BASRiS form for a UC or ESA application, the work capability team will try to obtain the SR1 form for these clients. 

To reduce the potential burden on clients and clinicians, Social Security Scotland can accept an SR1 confirming that the individual is terminally ill. Only in situations where the client has applied for Scottish Government disability assistance, such as ADP, using a BASRiS first, will they then need to obtain the additional SR1 form to apply for UK Government benefits.  

Officials are also working with DWP to ensure guidance and communications are aligned on this issue. 

Members suggested the Scottish Government consider adding a box to the BASRiS form so that clients can confirm whether they meet the UK Government definition of terminal illness. Officials noted that the new definition of terminal illness is an important change for disability benefits so asking clients to specify a life expectancy would be a step backwards and does not align with the values and policy approach of the Scottish Government. 

Verbal BASRiS form discussion

Social Security Scotland colleagues updated on an issue that practitioners are having with the BASRiS form. Practitioners are struggling to get a paper version of the BASRiS form from Health Care professionals within the 28 day completion period following receipt of a verbal BASRiS. 

Practitioners make a phone call to health care professionals as a reminder, but these are still taking time. This delay does not impact a client’s payment however it is important these are completed for audit purposes, and it means health care professionals cannot claim the fee. Colleagues asked members for advice on what the next steps should be when a paper BASRiS form isn’t received. 

Members suggested agreeing a way forward with this offline. 

Update on digital BASRiS

Officials updated that the live web form will be available by the end of year. The SRTI Information Hub will be updated with the URL so that users can access this. Officials confirmed that the webpage is shared through the SWAN Network so there shouldn’t be any cyber security concerns. Testing has been done to ensure the page can’t be accessed outside of the NHS network and internal checks will be done when a BASRiS form is received to ensure it has come from a legitimate source. 

The form will not pre-populate any information, but this is something that may be considered in the future. Members noted that the NHS has pre-population for a number of other forms, so getting the data to do this should not be an issue. Members suggested contacting NHS National Services Scotland (NSS) to discuss this further. 

Officials also gave an update on an issue causing concern to Social Security Scotland colleagues. Both the BASRiS form and the BASRiS fee claim form were landing in the same work queue causing concern as the BASRiS form needs to be processed instantly whereas there is more time to process the fee claim form. To resolve this the fee claim forms have been moved for now and a new work queue will be established for these. As a result, minor changes have been made to internal guidance. 

Agree priorities for future meeting

Priorities for the next meeting include:

• learning from ADP national launch – systems, processes, communications
• digital BASRiS update 
• feedback from practice managers network by Kirsty Maciver
• update on UC/ BASRiS Communications and Guidance
• Social Security Scotland colleagues to share feedback from Practice Managers and GPs 

Members and officials agreed that some work could be done through email correspondence and shorter meetings ahead of the next meeting, which will be held in March 2023. 

Any other business and close

The Chair thanked members for attending and closed the meeting.