Disability benefits - supporting information: qualitative research

2. Applicants' understanding of supporting information and experiences of providing it

This chapter covers applicants' perceptions of the purpose of supporting information, where it should come from and what it should contain. It describes their experiences of, as well as enablers and barriers to, obtaining and submitting supporting information.

Perceptions of supporting information

Views on the purpose of supporting information and where it should come from

Applicants did not have any objections to being asked to provide supporting information as part of an application and they expected to have to provide something. When asked what supporting information is for, applicants used language which Social Security Scotland aims to avoid. Their explanations very much centred on the idea that supporting information is "proof" or "evidence" to corroborate the information given in their application form, but they thought this was perfectly reasonable. This was the predominant view for both ADP and CDP applicants. Related to the idea of supporting information as "evidence", was the view that it is necessary to prevent fraud because there will always be some dishonest people. Further points made on the purpose of supporting information were that it allows staff to build a fuller picture of an individual's needs and come to a fair decision.

"Essentially I was saying that [son's name] has ASD [Autistic Spectrum Disorder] and therefore has extra needs – so it [supporting information] was backing that up, justifying it, proving that I wasn't lying."

(Successful CDP applicant)

There was a tendency, among both ADP and CDP applicants, to focus on information from medical professionals. This is in contrast to the guidance to individuals about the different types of supporting information that can be provided. The predominant view was that this was the most valuable type of supporting information as it best "backs up" what they had said in their application form. That said, the emphasis placed on this varied from individual to individual, depending on how much value they placed on supporting information from their wider support network. This was the value both from their perspective and what they thought Social Security Scotland would want. GPs and consultants were seen as important sources of supporting information from medical professionals, although other professionals such as occupational therapists and community psychiatric nurses were also mentioned as providing very helpful supporting information. CDP applicants tended to talk about a broader range of professionals such as educational psychologists, early years practitioners, teachers, and health visitors. This reflects the number of professionals involved in supporting disabled children and, possibly, the high proportion of CDP applicants in our sample whose children were neurodiverse, for example, they had Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD). Nonetheless, "proof" that their child has a condition from a medical professional was still seen as the most valuable type of supporting information.

Some clients felt that supporting information should come from a professional because they can be trusted and are held to certain ethical standards. This group saw statements from an individual's wider support network as less valuable because it could come from a biased perspective and therefore pose a risk of people saying what they think is needed to make a successful application. Other applicants felt such statements were very useful in providing a fuller picture of the person's day-to-day needs. As mentioned above, this group placed slightly less emphasis on the importance of supporting information from professionals (medical or otherwise) but generally saw value in both types of supporting information. One participant felt strongly that no supporting information from a professional should be required if wider support network supporting information is submitted. That view came from an unsuccessful applicant who was unable to provide supporting information from a professional, but did submit a statement from her mother (this case will be discussed in more detail later in this section).

Third Sector staff and local delivery Client Support Advisors commented that awareness of the different types of supporting information is generally low among the applicants they support, especially awareness that it can come from their wider support network. According to both Third Sector and Client Support Advisors, lack of awareness or understanding is greater among those who could be considered the most vulnerable (discussed further below under Barriers to providing supporting information).

"I have to explain things maybe slightly differently to how it's written on the form, to help clients understand… when you mention [supporting information] their minds seem to just go blank. They don't know what we want, they don't know what they have in the house… so I list plenty of examples to help them think of things."

(Client Support Advisor)

Staff perspectives on the purpose of supporting information and where it should come from are covered in Chapter 4 under Staff perceptions of supporting information.

What useful supporting information should contain

Views were mixed on what 'useful' supporting information would look like, in line with the different views discussed above on the value of supporting information from professionals and from an individual's wider support network. There were those who focussed on only medical documents (such as doctor's letters and reports, diagnosis letters and prescription lists) and others who felt supporting information should provide a more rounded picture of a person's daily routine and needs. This type of information was seen as something that could come from an individual's wider support network, or from professionals who have regular contact with individuals, such as community psychiatric nurses. On the other hand, GPs were generally viewed as not being able to provide this broader picture:

"The doctor sees you, if he is lucky, once a year, or once every couple of years, whereas your wife sees how you cope with things on a daily basis."

(Successful ADP applicant)

Still others emphasised that both types of supporting information content could be useful (medical/diagnosis related and day-to-day life related). Parents applying for CDP on behalf of their child tended to talk slightly more about supporting information building a broader picture of the impact the child's condition has on the different aspects of family life. This includes the impact on the child, the impact on parents and, sometimes, the impact on siblings. Parents of autistic children emphasised this point because their child may "mask" their condition and act very differently in different settings. It was therefore useful to be able to provide supporting information from a range of sources including both their wider support network and professionals. A further view was that supporting information could provide detail on the "level of disability".

Unsuccessful applicants and supporting information

Five unsuccessful applicants were included in the research. One of these applicants believed that supporting information was a main reason for her application not being successful. She was not able to be seen by her GP and so was not able to obtain the supporting information she wanted for the application. For a second applicant, it was unclear whether she thought that lack of supporting information was a reason but she did have an issue with not being able to access her GP. We do not know what reasons were provided to these individuals in the decision letters for the denial of their applications. We therefore cannot say for certain whether a lack of supporting information was the reason or whether they did not meet the eligibility criteria for an award. In the other three cases, issues with supporting information were not seen by the individuals to be the reason for the unsuccessful decision.

Like successful applicants, the unsuccessful applicants' views on the purpose and role of supporting information reflected their individual situations. For example, an applicant with long Covid felt that the purpose of supporting information should be to explain more about the impact the condition has on someone's life, rather than to confirm a condition. This applicant submitted supporting information from her mother but had not seen a professional because her GP surgery was so busy that she could rarely get through on the phone. She had not managed to secure an appointment by the time she sent in her application. Another unsuccessful applicant provided a prescription list and a letter from a Chronic Obstructive Pulmonary Disease (COPD) clinic, and felt this should have been enough to "prove" her eligibility for ADP:

"I… just thought with giving them the prescriptions and the COPD stuff that that would be enough… the tablets I take for the migraines they knock me out, I just sleep. They are so strong, they just knock you to sleep, but I can't prove it to them, I wish I could […] I don't even know if I could get to the doctor to say look, can you please give me this information, because you don't get past the lassie that answers the phone."

(Unsuccessful ADP applicant)

Applicants' experience of the supporting information process

Overall satisfaction with the supporting information process was very high among successful applicants. It was described as straightforward and not stressful. Satisfaction with the process was highest among those who were able to submit supporting information at the start of their application, or after a phone call with a Case Manager to clarify what to upload. Those who had more contact with Social Security Scotland, for example, because they wanted them to obtain supporting information for them, felt things could have happened more quickly or efficiently. However, they were still satisfied overall, not least because they found staff very helpful on the phone. Unsuccessful applicants who had submitted supporting information were critical of the process because they felt that what they had provided should have been enough to ''prove'' they are entitled to the benefit.

Applicants with previous experience of applying for DWP benefits tended to be the most positive about the supporting information process. Even those who had not applied to the DWP before had a general expectation that applying for any disability benefit would be difficult and stressful. However, they were pleasantly surprised when this was not the case.

Understanding what to provide

Levels of understanding of exactly what to provide as supporting information were very mixed. Misconceptions and a lack of awareness of what they could provide were apparent among both successful and unsuccessful applicants. They were also apparent among those who felt confident about what they should provide and those who were not sure what was needed. These misconceptions and lack of awareness align with the findings above, and the mixed perceptions of what useful supporting information should look like and where it should come from. Specifically, these misconceptions included:

• Thinking supporting information should only be from medical professionals.
• Not knowing that supporting information could be from their own, or their child's, wider support network.
• Not knowing that Social Security Scotland can contact professionals on their behalf (discussed in more detail below).
• Not understanding that one piece from a professional may be all that is required, or that they do not necessarily need to provide a large amount of documentation.
• Not knowing that Social Security Scotland cannot (currently) directly contact their wider support network even when their contact details are provided. One applicant, in particular, was expecting his wife to receive a call and wondered why that did not happen. (See Asking Social Security Scotland to obtain supporting information on their behalf for more details on this issue).
• Being unsure whether having no diagnosis would work against them.
• Expecting that staff would probably give more weight to supporting information from professionals versus supporting information from an individual's wider support network.

On the last point, there were mixed views on the concept of equal consideration: there were those who felt it would support fair decision-making and those who felt strongly that supporting information from family and friends should be given less weight because they have a "vested interest" in the outcome. Note that we used the term 'equal weight' when asking participants about this. However, the Scottish Government's decision-making guidance for staff now uses 'equal consideration' because, even though all supporting information should be considered equally, if one piece of supporting information provides a more detailed account of the individual's situation or condition, then more weight will be given to that piece of supporting information when it comes to making a decision.

Those who had a better understanding of supporting information tended to have previous experience of applying for other benefits or support. Applicants who worked in areas such as health, education, or government, or had family members who did, also had a better sense of what to provide. Those with family members who had this kind of experience asked for their thoughts or advice on how to approach the application but usually went on to complete their application and decide what supporting information to provide themselves.

There were some mentions of searching online for information and reading about supporting information on the Scottish Government or Social Security Scotland websites prior to starting the application. However, guidance included in the application itself was the main source of information for applicants.

"It [the online form] was saying 'could you provide information about your conditions, how it affects your life, it can be anyone, someone that you know or a professional.' So that side of things was good for me because I knew what to send."

(Successful ADP applicant)

Views on the usefulness of the supporting information guidance in the application form were mixed. Some said the instructions were 'clear' and the examples were 'helpful', but others thought the requirements were not well communicated. Despite not being completely confident about what was required, the latter group usually went on to submit their application anyway, sometimes without any supporting information. They then went on to have phone conversations with Case Managers who explained how to provide supporting information and helped them work out what would be most useful in supporting their application. These phone calls were either initiated by Case Managers who had received the application with no or insufficient supporting information, or by the applicant calling for an update on their application or asking about supporting information. Feedback on these interactions was very positive from successful applicants: staff were described as "really helpful", "understanding", "approachable", "patient", and "compassionate". Overall, these phone conversations were seen as very valuable for understanding what supporting information to provide. Applicants also gave examples of staff clarifying aspects of policy, such as the fact that applications can progress with no supporting information and that Social Security Scotland can obtain supporting information on behalf of applicants.

Unsuccessful applicants were less positive about their interactions with staff. Some felt neutral or quite positive about staff because they were respectful and polite. Ultimately, however, they felt that staff were not helpful because their application was unsuccessful and they felt frustrated by the whole process.

What shaped when, and how, applicants provided supporting information

Throughout the interviews, participants raised issues that enabled us to identify factors which appeared to enable them to provide supporting information, and factors which appeared to be barriers. The applicants we interviewed tended to have provided at least some supporting information with their application. It should be noted that this sample of applicants is not representative of the wider population. Indeed, staff stated that most applications arrive with no supporting information.

Enablers to providing supporting information

The following factors were "enablers":

• Having experience of similar administrative tasks, often through work, or having someone in their household who had this experience.
• Being confident online and technologically literate or having someone in their household who was.
• Having supporting information to hand. Sometimes this was because they had previously applied for other support. Parents, in particular, described having folders in which to keep everything relating to their child's health.
• Receiving support from Case Managers over the phone.
• Receiving support from Client Support Advisors working in local delivery.
• Receiving support from a charity. One applicant had attended a seminar about how to apply for ADP and another had received support from a Citizens Advice Bureau and had been advised what supporting information to upload.
• Believing that providing supporting information themselves may speed up their application.
• Having previously applied for disability benefits or other support. These applicants thought they might as well send everything they had to cover all potential questions. Some of those with previous experience of applying to the DWP assumed they would need a similar amount of documentation.

On this last point, it should be noted that Social Security Scotland do not require every detail of the application to be backed up by supporting information, in line with the Policy commitments. These applicants were therefore quite possibly sending more than was required.

Barriers to providing supporting information

As noted above, most of the applicants we spoke to had provided supporting information with their initial application. Among those who did not, the reasons were:

• Not having documents at the time they submitted the application and assuming they would be asked for them later.
• Not realising that it would likely speed up their application if they provided supporting information at the start, and assuming that Social Security Scotland would contact the professionals they had named if the information on the application form was insufficient.
• Not realising that they had been asked to provide any supporting information.
• Thinking they did not have anything that would be useful.

These applicants either provided supporting information later, with guidance and advice from Case Managers, or Social Security Scotland obtained the supporting information on their behalf.

The following factors hindered other applicants in providing supporting information (whether at the start of their application, or later on, after speaking to a Case Manager):

• Not having a clear understanding of the different types of supporting information that can be submitted.
• Not being able to access a GP or not having seen a health professional. This was more common for those applying for ADP. This could be due to difficulties getting an appointment or because of accessibility issues relating to the disability or health condition.
• Not having family nearby or not having much of a support network who could provide statements.
• Not being comfortable online or not having internet access at home.
• Not keeping medical letters or documents.
• Worrying about not yet having a diagnosis.
• Experiencing difficulties in completing tasks because of poor physical or mental health. This sometimes led to difficulties in understanding/retaining the supporting information instructions on the online form.

Interviews with Third Sector staff and local delivery Client Support Advisors highlighted the scale of barriers faced by those with particularly severe mental health difficulties:

"He had such a small [social] circle. He had extreme paranoia and was so anxious, he doesn't like leaving the house at all. Doesn't go and see a GP because he has distrust in them… The only person he's got is his mother but he doesn't tell her the true extent of his mental health problems… He really did have nothing to provide in terms of supporting information."

(Client Support Advisor)

These staff also highlighted other groups who were more likely to struggle with providing supporting information and/or understanding what is required:

• People with addictions.
• 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.
• People with low levels of literacy.

Linked to the second point made in the 'barriers' section above about lack of contact with health professionals, Third Sector staff and Client Support Advisors in local delivery indicated that it could be because the applicant has not used NHS services recently or has never used them. They said this was sometimes due to mental health issues or due to cultural barriers among those relatively new to Scotland. It should be noted that these individuals may have good reason for not being able to supply supporting information, and Social Security Scotland have discretion to make an award in these cases, in line with the policy commitment (see Where supporting information is not available).

Asking Social Security Scotland to obtain supporting information on their behalf

Applicants' awareness of the policy commitment that they could ask Social Security Scotland to obtain supporting information on their behalf was very mixed. Some applicants were aware because they had noticed it on the application form, some were aware after talking to their Case Manager, while others did not know about it at all.

A number of applicants who had provided supporting information had also given contact details for their GP and, sometimes, other professionals and family members. This was in the section of the form designed for those asking Social Security Scotland to obtain supporting information. However, applicants explained that they were filling in contact details where asked, and were not aware that, by doing so, they were effectively asking Social Security Scotland to obtain supporting information on their behalf.

One father, who felt he had no suitable supporting information, was very relieved when the Case Manager explained that Social Security Scotland could obtain it:

"Once I had the phone call [with Case Manager who reassured him he could just give consultants' names], the pressure was taken off me […] but it would have been nicer to know from the beginning that that was enough."

(Successful CDP applicant)

Those who had asked Social Security Scotland to obtain supporting information gave a range of reasons for doing so:

• They did not have any supporting information at home already and felt it would be easier.
• They thought the professional would be more likely to provide the supporting information to Social Security Scotland.
• They thought that they would get a response but Social Security Scotland might get a quicker response.

Although speeding the process up was one of the reasons given for asking Social Security Scotland to obtain supporting information on their behalf, applicants did report that Social Security Scotland experienced delays in obtaining the supporting information, from GPs in particular.

Applicants who did not ask Social Security Scotland to obtain supporting information for them also gave a number of reasons for this:

• They thought it would be quicker to provide the supporting information they already had at home.
• They preferred to have more control over supplying supporting information by doing it themselves.
• They felt that, because they were able to obtain the supporting information themselves, they should do so. They thought this would free up Social Security Scotland staff time to help those who were less able to obtain it.

At the moment, Social Security Scotland can only request supporting information from professionals. However, some applicants had provided contact details for their (or their child's) wider support network and therefore expected that Social Security Scotland would reach out to these contacts. In the future, Social Security Scotland may be able to obtain supporting information from wider support networks and we asked applicants for their views on this. In general, they felt it was a good idea. However, there was some concern about fraud from people who did not realise that applicants could currently provide supporting information from their wider support network. There was also a concern about family members being called 'out of the blue'.

Applicants who requested supporting information for themselves

Overall, applicants who requested supporting information on their own behalf indicated that doing so did not cause them any extra stress or anxiety, and that doing so suited them better than asking Social Security Scotland to do it for them. Those who requested supporting information from professionals did not have any concerns about doing so. However, those who said it took many weeks to get a written response from their GP found the wait frustrating. Applicants who asked family members or others in their wider support network for a statement had no concerns or problems with this either. Moreover, reasons for not providing supporting information were not to do with any awkwardness or lack of confidence in approaching people (see Barriers to providing supporting information). Applicants did not generally find it emotionally difficult to collect their supporting information. However, one parent did say it was hard to re-read the report and diagnosis letter about her autistic child.

Uploading supporting information

Satisfaction with the online system for uploading supporting information documents was high. It was seen as convenient and easy to use, in line with the outcome that the supporting information process is simple and straightforward. However, it was mentioned that those individuals who are not as "tech savvy" may have more of an issue with the online system. Applicants who were less familiar with IT, or were unsure how to upload documents, said that Social Security Scotland staff were helpful in talking them through how to do that.

Applicants who completed paper applications sometimes did so because they were not aware they could complete the form online. One of these applicants then uploaded their supporting information online after a Case Manager talked them through how to do it.

For three applicants, there was an issue with some supporting information documents going missing (both electronic copies and paper copies). However, these applicants were satisfied with how these issues were handled and resolved by Case Managers.