Disability benefits - supporting information: qualitative research

Executive summary

Background

In July 2022, the Scottish Government commissioned Ipsos Scotland to undertake qualitative research into individuals' experiences, perceptions, and the associated impacts of supporting information in the application of disability benefits. Specifically, the research focussed on two devolved disability benefits administered by Social Secrity Scotland:

• Child Disability Payment (CDP), which replaces Disability Living Allowance for children administered by the UK Department for Work and Pensions (DWP), and was rolled out across Scotland in November 2021 following a pilot.
• Adult Disability Payment (ADP), which replaces Personal Independence Payments (PIP) and Working Age Disability Living Allowance administered by DWP, and was rolled out across Scotland in August 2022 following a pilot.

This research is part of the Devolution of disability benefits evaluation strategy evaluating the policy impact of the devolution of disability benefits, with the overarching aims of understanding how a benefit is being implemented and what effects it has had, for whom and why.

The role of supporting information in disability benefits decision-making

People applying for CDP or ADP complete an application form in which they provide details of their conditions or disabilities and the impact these have on them day-to-day. They are also asked if they will provide at least one piece of supporting information from a professional. This is someone who, in their professional capacity, is familiar with the individual and their needs. This could include people who work in health or social care, education, or any other professional who is involved in the individual's treatment or care. The main role of this supporting information is to broadly confirm the applicant's condition(s), disability, or level of need.

Applicants can also provide supporting information from their wider support network. This can give insight into the impact the condition or disability has on the individual on a daily basis. The wider support network can include, amongst others, family members, partners, friends, and unpaid carers.

Supporting information plays an essential part in the decision-making process: it provides additional detail on an applicant's level of need and allows Case Managers to build a holistic picture of the applicant's circumstances. Following from that it enables Case Managers to make a robust entitlement decision.

The following policy commitments have been made in relation to supporting information:

• Clear and accessible guidance on what supporting information is most useful. This includes internal guidance for Social Security Scotland staff and external guidance for applicants and other individuals providing supporting information.
• Case Managers (Social Security Scotland staff) work collaboratively with individuals to identify the most useful supporting information.
• Case Managers can gather supporting information on the individual's behalf.
• Supporting information only needs to broadly support, rather than confirm every detail, in the application or review form.
• Case Managers have discretion to make an award in the absence of supporting information.
• Generally, only one piece of supporting information is sought from a professional per application.
• Supporting information both from professionals and the individual's wider support network is accepted.
• Different types of supporting information are given equal consideration.

Aims of the research

The project sought to answer the following research questions:

1. Do applicants understand what supporting information they should or could be providing to support the decision-making process as much as possible?

2. Do applicants feel that their supporting information has been considered fairly?

3. What impact does supporting information have on Case Managers' decision-making process?

4. Is the process of requesting and obtaining supporting information done in line with policy commitments?

Methods

The research took a qualitative approach. Semi-structured interviews were used to explore the perspectives and experiences of:

• Applicants: 22 CDP applicants (i.e., parents/carers applying on their children's behalf) and 20 ADP applicants were interviewed by phone or video call or face-to-face.
• Social Security Scotland staff who use supporting information to help make decisions about awards as well as senior staff who manage them and have oversight of the processes: 31 members of staff were included in face-to-face focus groups or depth interviews.

To provide further insight into the experiences of some of the most vulnerable applicants who need more support, we also interviewed:

• Client Support Advisors who work for Social Security Scotland in local delivery teams across Scotland and provide face-to-face, video and phone support to applicants. Four Client Support Advisors were interviewed by video call.
• Third Sector staff from advice and advocacy charities who provide support to people in relation to the overall application process including supporting information. Two members of staff from different charities were interviewed by video call.

All fieldwork took place between September 2022 and January 2023.

Main findings on the research questions

Question 1: Do applicants understand what supporting information they should or could be providing to support the decision-making process as much as possible?

It is clear that many applicants do not fully understand what supporting information they should or could be providing. It is a common assumption that some sort of medical information will be required and so there are applicants who do provide that. Some applicants might not have access to medical information. Due to the assumption that some sort of medical information is required, this can lead them to being unsure about how to proceed and, in turn, not submitting supporting information from other professionals that might be equally or more helpful.

For those who are unsure what to do, phone calls with Case Managers are very helpful in clarifying what is required. (Case Managers are the Social Security Scotland staff who are responsible for reviewing application and review forms, supporting information, and making entitlement decisions on cases). This reinforces the importance of Case Managers having a good understanding of supporting information and therefore being clear on exactly what is required.

There is scope to communicate more clearly to applicants that supporting information is needed, what form it can take, and that it may speed up the decision if it is provided with the application.

Only those who had submitted an application were included in the research. It is worth noting that many of the barriers to supplying supporting information, and misunderstandings about what could be submitted, may have deterred others from making an application at all.

Question 2: Do applicants feel that their supporting information has been considered fairly?

Successful applicants did feel that their supporting information had been considered fairly. They explained that this was because they received an award which they felt they deserved and/or because the letter detailing the reasons for the decision showed that all their information had been considered thoroughly.

Some unsuccessful applicants did not think their information had been considered fairly, for example, they suggested that they may have been unfairly disadvantaged by not being able to provide supporting information from a health professional and having to provide it from their wider support network instead. They felt this was not given the same consideration that a letter from a health professional would have been.

Question 3: What impact does supporting information have on Case Managers' decision-making process?

Case Managers generally see supporting information as important to decision-making, although the impact varies depending on the application being considered. It has more of an impact if the application form lacks detail or if the individual has a less common condition or a complex condition with which staff are less familiar.

Fluctuating conditions (particularly fluctuating mental health conditions) were also mentioned as the impact on an individual can vary day by day: this can make decision-making more difficult as it can be harder to know how often something happens, or whether someone's condition may be generally improving/deteriorating which may make a difference to the award decision. In addition to establishing entitlement, supporting information can also be important in helping decide on the appropriate level of award and review period.

However, where the applicant has supplied detailed information in the application form, supporting information seems to play less of a role in decision-making. This was because Case Managers felt that the application form contained sufficient information about the impacts of an individual's condition in order to allow them to make an informed decision. This is in keeping with Case Managers approaching applications from a position of trust (see further details in the Logic Model in Appendix 2).

The quality of supporting information was seen as more important than the quantity. CDP Case Managers mentioned that education plans and Autism Spectrum Disorder (ASD) diagnostic reports were particularly useful in decision-making.

Supporting information from an individual's wider support network was seen as especially helpful when there was scant information on the application form.

Question 4: Is the process of requesting and obtaining supportinginformation done in line with policy principles?

From the way staff described their approach and their interactions with applicants, it was apparent that they are acting in a way that reflects the Social Security Scotland core principles of dignity, fairness, and respect. They clearly saw their role as supporting disabled people who met the eligibility criteria, rather than being a 'gatekeeper' to an award or an 'investigator' of someone's eligibility. Staff referred to individuals in a respectful way that demonstrated they were starting from a position of trust. They sensitively worded conversations with applicants about supporting information to gauge whether they were happy and able to provide any themselves, and to avoid any undue stress. Staff were very clear that they did not need to obtain supporting information to support everything in the application form.

However, there was also the perception of supporting information being utilised as 'evidence' or 'proof', and confusion about whether 'equal weight' was still applicable (i.e. whether staff should be giving equal weight to different types of supporting information). While these are important policy commitments, staff who held these views did not appear to be handling cases in a markedly different way to their colleagues and they still appeared to be taking a person-centred and supportive approach.

Applicants were generally extremely positive about their interactions with staff. They felt they had been treated with dignity, fairness, and respect. Their experience had a positive impact on their perceptions of Social Security Scotland, their likelihood to contact them and their likelihood to apply for other benefits in the future.

The main issue affecting applicants' satisfaction are the delays that Social Security Scotland encounter in obtaining supporting information from professionals on their behalf. This creates a bottleneck in the whole system.

Additional insights on enablers and barriers to supplying supporting information

The main factors which made it easier for applicants were:

• Having experience of similar administrative tasks.
• Being confident online and technologically literate.
• Having supporting information to hand.
• Receiving support from Case Managers over the phone.

The main factors which made it more difficult for applicants were:

• Not realising that they had been asked to provide any supporting information.
• Not having a clear understanding of the different types of supporting information that can be submitted.
• Not realising that it would likely speed up their application if they provided supporting information at the start.
• Not being able to access a GP or not having seen a health professional (due to difficulties getting an appointment or accessibility issues relating to the disability or health condition).
• The perception that not having a diagnosis would mean they would not be able to supply supporting information.

Staff also highlighted other groups who were more likely to struggle with providing supporting information and/or understanding what is required: people with severe mental health difficulties; people with addictions; those who experience difficulties completing tasks because of poor physical or mental health; the Gypsy/Traveller community; some religious communities (particularly where women might be less likely to access a GP); homeless people; prison leavers; people with little or no English; and people with low levels of literacy.

Key recommendations and areas for consideration for the Scottish Government and Social Security Scotland

The following key recommendations and areas for consideration come predominantly from applicants and Social Security Scotland staff themselves. They are, broadly speaking, presented in order of importance. This is based on what we judge will have the biggest impact on the applicant experience.

Reduce delays in obtaining supporting information from professionals

The delays experienced by Social Security Scotland staff in obtaining supporting information from professionals, and GPs in particular, was the main issue affecting applicant satisfaction with the process. It was also one of the biggest frustrations for staff because it creates a bottleneck in the system and increases processing times. We recommend that the Scottish Government and Social Security Scotland work with GPs, the NHS, and Local Authorities to find ways to ensure that supporting information requests are responded to more quickly. We recognise that these organisations face considerable pressures and making progress on this will not be straightforward.

Clarify the guidance on supporting information for applicants

Many applicants do not fully understand what supporting information they should or could be providing. We recommend reviewing the guidance included in the application form and elsewhere with the aim of clarifying:

• What supporting information to include, who it can come from, and what is 'required' – possibly in a separate guidance document.
• That help is available if someone is unsure what supporting information to provide.
• That, ideally, supporting information should be provided with the application and that this will likely speed up the process.
• That, ideally, one piece of supporting information from a professional should be provided.
• That supporting information can also be provided from the individual's wider support network.
• That Social Security Scotland can obtain supporting information on behalf of individuals.
• That an award can be made in the absence of a diagnosis (whether or not a formal diagnosis is available, is irrelevant to the decision-making process).

In relation to the point about Social Security Scotland being able to obtain supporting information on an individual's behalf, there is a tricky balance to be struck. It is important to encourage those who are able to obtain and provide supporting information themselves to do so, while making it clear to those who would have difficulty, that Social Security Scotland can contact professionals and request it for them. The best approach may be to emphasise that, if individuals can provide supporting information themselves, this will significantly speed up the processing of their application.

More training and guidance for Case Managers on what to do if there is no supporting information with an application

There should be more of a focus in initial training on what to do if there is no supporting information with an application and how to go about obtaining it. Staff reported that the example cases they were given in their initial training all had supporting information provided whereas, in practice, most applications arrive with no supporting information. They also suggested that the decision-making guidance on this could be made clearer.

Clarification of some key issues for Case Managers

There were a few key issues where at least some Case Managers had misunderstandings or were unclear what the position was. We recommend:

• Clarifying that the decision-making guidance on giving equal consideration to supporting information from different sources is not superseded by the requirement to have one piece of supporting information from a professional.
• Addressing the bias towards supporting information from professionals, and medical professionals in particular, that was evident among some Case Managers. This should be addressed in initial training, on-going training and in the decision-making guidance.
• Addressing questions around the tension between a position of trust and the need to seek more clarification and additional information in some cases.

Improvements to Social Security Scotland internal systems

There were a number of suggestions for improving systems so they do more to help Case Managers obtain supporting information. Suggestions included:

• Developing a system that would allow more direct contact with professionals in the way that email does.
• Adding a free text box for CDP staff to ask bespoke questions of professionals (ADP staff can already do this).

More training for Client Support Advisors and Third Sector staff

Client Support Advisors in local delivery said the training they had received on 'a day in the life of a Case Manager' was very useful in helping them to understand the importance of supporting information. This session involved being told about supporting information from a Case Manager's point of view, among other aspects of their job. It was suggested that this course should be a requirement for new joiners.

More guidance and training should be provided to Third Sector organisations who might support individuals with their applications. Third Sector staff wanted to better understand the role that supporting information plays in decision-making. Raising awareness of the 'day in the life of a Case Manager' training would help in this regard. The guidance/training could also address some of the areas on which Third Sector staff appeared to be less clear:

• that Social Security Scotland is asking for one piece of supporting information from a professional.
• that an additional written statement produced by an individual themselves is not considered supporting information.
• that it is not standard for GPs to be contacted.

Further recommendations

Further recommendations relate to:

• Improvements to Social Security Scotland's decision-making guidance for staff.
• Ensuring consistency between decision-making teams.
• Sharing information on re-determinations and appeals with Case Managers to enable learning.
• Supporting Decision Team Managers to implement policy changes.
• Immediate checks on whether an application includes supporting information.
• An online tracker to show individuals what stage their application is at.
• Reviewing the wording of decision letters to unsuccessful applicants.
• Highlighting that Emergency Care Records are useful supporting information.
• Improving the system that applicants use to upload documents so that it is even clearer for those that are less "tech savvy" and to avoid electronic documents getting lost (which happened in a small number of cases).
• Improving local delivery Client Support Advisors' devices to allow them to effectively upload supporting information.