Disability benefits - supporting information: qualitative research

4. Staff understanding of supporting information and approaches to obtaining it

This chapter examines how Social Security Scotland and Third Sector staff understand supporting information, how they approach requesting and obtaining supporting information, and the challenges they faced in doing so. Social Security Scotland staff involved in this part of the research were Operations Managers, Decision Team Managers, Case Managers and local delivery Client Support Advisors. The Third Sector staff interviewed were Advisors working in advocacy and advice organisations.

Staff perceptions of supporting information

Staff at all levels understood supporting information to be information to support an application, and that it can come from professionals and/or from an individual's wider support network. Case Managers were asked how they would explain supporting information and its purpose to a member of the public. Responses demonstrated a consensus that supporting information can be information from any source that provides a fuller picture of the individual's needs, disability, or condition. The purpose of supporting information was seen as to support decision-making by confirming or clarifying what was provided in the application form.

While staff at all levels were aware that supporting information should not be described as "evidence", some Case Managers did use the term intermittently (but still used the term 'supporting information' in the main). In line with applicants' perceptions (see Perceptions of supporting information) these Case Managers held the view that it is, ultimately, "evidence" to corroborate at least part of what is provided in an application form. One Case Manager suggested that "evidence" was a more straightforward way to think about it and potentially an easier term for applicants to understand.

"Supporting information is used to support and evidence the impact your conditions have on your daily living and mobility needs. I know I have used "evidence" there, but it is, that is what it is for."

(ADP Case Manager)

Nevertheless, staff who felt "evidence" could be a useful term, still demonstrated they understood the policy intent behind using different language to DWP and generally appeared to be working in alignment with the policy principles, including starting from a position of trust and only seeking enough supporting information to broadly support the application.

ADP and CDP staff demonstrated a clear understanding of the different types of supporting information and roles that they have, including the value of supporting information from an individual's wider support network. The way these different types of supporting information are used in decision-making is covered in more detail in Chapter 5 Value of different types of supporting information and 'equal consideration. Like ADP applicants, ADP Case Managers spoke slightly more often about supporting information coming from medical professionals throughout the discussions. CDP Case Managers were more likely to talk spontaneously about supporting information helping them to understand the child's needs. This could reflect a difference in the frequency of applications made for or by people with different conditions or disabilities under ADP and CDP.

The Third Sector staff we spoke to had a good basic understanding of the purpose of supporting information. They also said that, as part of the support they provide, they advise applicants to provide supporting information with their initial application so the process is not prolonged. They described supporting information as being used to help Case Managers reach decisions. However, one member of staff said that they were unclear on its "official purpose" as they had not accessed any Social Security Scotland guidelines or had any "practical advice". It was also not clear to some staff that Social Security Scotland is asking for one piece of supporting information from a professional or that an additional written statement produced by an individual themselves is not considered supporting information. There was also a comment that there is "no consistency in whose doctors are contacted [for supporting information] and whose aren't". This may be related to confusion about the purpose of providing GP contact details and an assumption that it is standard for GPs to be contacted. Third Sector staff suggested further training on supporting information to help them stay up-to-date on policy and to better understand the role supporting information plays in decision-making.

Staff understanding of the processes for obtaining supporting information

Case Managers and Decision Team Managers felt confident in their understanding of the processes involved in obtaining supporting information. Case Managers indicated that obtaining supporting information took up a large proportion of their time. They said that this is because the majority of applications they receive have no, or insufficient, supporting information to allow them to make a decision straight away. Note that the applicants who took part in this study tended to say that they did provide supporting information with their application. As noted in the Limitations of the research section in Chapter 1, the applicant sample is unlikely to be representative of the wider population of people applying.

In line with decision-making guidance, ADP and CDP staff took a similar approach to obtaining supporting information. This typically involved Case Managers taking the following steps:

1. Reviewing the application form and any supporting information.

2. Deciding whether more supporting information is needed and how to obtain it.

3. Calling the applicant to ask about possible supporting information (where appropriate) or using systems to request supporting information from GPs, NHS or local authority staff (this is done only with consent from individuals which is usually provided when contact details are included in the application form).

4. Following up with professionals for supporting information which has not yet been received, at 28 and then 56 days after a request is submitted, and updating the individual on the progress of their decision.

Case Managers emphasised that they would only phone an applicant about supporting information if it was clear from their application form that they were happy to be called. Staff said applicants were usually happy to receive a call, particularly if the result helped them realise that they already had suitable supporting information at home. The way that staff spoke about the contact they had with applicants conveyed a real sense that they were taking a sensitive and collaborative approach. This was very much in keeping with applicant's views and in line with the policy commitment of Case Managers helping individuals identify the most useful supporting information.

"It is a collaborative approach between ourselves and the client and [we are] making sure that they are involved in the decision that we are making in terms of who we are going to reach out to, and working with them to find what they think would be the best supporting information to support their case."

(CDP Decision Team Manager)

ADP Case Managers were more likely than CDP Case Managers to contact GPs for supporting information. This was because of the nature of the conditions, care and treatment that ADP applicants typically had compared to CDP applicants who often had contact with a broader range of professionals. However, there was also a view held by ADP Decision Team Managers that ADP Case Managers may do this more because of an unconscious bias towards medical professionals, rather than other professionals. This is in contrast with the policy commitment of one source of supporting information being sought from a professional more generally, rather than a 'medical' professional specifically. In addition, ADP managers said that Case Managers were less familiar with the systems used to contact other types of professionals, whereas they frequently use the system for GP requests and so are more familiar with this. This was also suggested as a reason why they may put in a request to a GP before considering other NHS or local authority staff.

Almost all Case Managers who took part in a focus group had been in their roles since just before, or shortly after, the benefits were launched. They therefore felt confident about knowing when more supporting information may be required, or when they had enough supporting information to be able to make a decision.

"The guys needed to learn the job in terms of what is eligible and what is not, what are all the different criteria, we have got our decision-making guidance they are constantly referring to. You know, what are the thresholds for all the different things."

(ADP Decision Team Manager)

ADP and CDP Decision Team Managers said they had received more questions initially on who to contact for supporting information or whether there is enough information to make a decision. However, they indicated that they were asked these things less frequently now their teams were more experienced.

One Case Manager was still unclear on the systems and processes around obtaining supporting information because she had just completed the initial training and started working on her own cases. She agreed with the more experienced Case Managers that learning about supporting information processes tends to happen 'on the job' via peers and Decision Team Managers.

Staff training on obtaining supporting information

While experienced Case Managers were familiar with the main processes for obtaining supporting information, they agreed that more training on the systems used for requesting supporting information would be useful to keep all teams up to date on the latest changes. Decision Team Managers echoed this view. One Decision Team Manager felt that more hands-on training, including interactive practice exercises, would benefit some staff.

There was a consensus among Case Managers that their initial training did not sufficiently prepare them for obtaining supporting information. They said that this was because it focused on how they would make decisions once supporting information was provided. They suggested that this training should include more detail on the systems used to request supporting information, tips on how to use the pre-written questions for professionals, and what to do when they receive an application with little or no supporting information.

Challenges around obtaining supporting information

Staff believed that the main challenge for them was delays in obtaining supporting information. They said that this is hugely frustrating because it creates a bottleneck in the processing of cases. These frustrations were also shared by applicants (see Asking Social Security Scotland to obtain supporting information on their behalf). Case Managers explained that these delays mean it takes more time to reach a decision which negatively impacts the applicant experience.

"I think that if everything goes the best-case scenario and they submit supporting information with their application, they have…fully gone over the things that we wonder about, like night needs and mobility needs, I can pull a case and make a decision within two hours that's the whole thing, but that very rarely happens.

(CDP Case Manager)

Staff understood why there was an option for Social Security Scotland to obtain supporting information on an individual's behalf. However, there was clear agreement – across all levels of staff – that placing more emphasis on individuals providing supporting information themselves (where possible) would help speed up decision-making and improve the experience for all applicants. They also thought it would increase job satisfaction among staff. It was clear that staff were very keen to help and support those who face barriers in providing supporting information, but they also want those who are more able to provide it to be encouraged to do so at the start. More senior members of staff saw the merits of the policy intent in this regard, but added they would like to see public facing information on supporting information repositioned to encourage more people to provide it upfront:

"There was obviously this policy intent that we wanted to make it as easy as possible to apply… remove the barriers and make sure that everyone that might be entitled to apply does apply… which I understand and fully support…there are a lot of communication issues. Aye, I think we just got the positioning of the whole benefit a tiny bit wrong."

(ADP Decision Team Manager)

Staff, including Client Support Advisors working in local delivery, saw the lack of a strong enough message encouraging applicants to provide supporting information with their application as the root cause of the low proportion doing so. These staff felt that the message that providing supporting information when submitting an application is not mandatory leads some applicants to think it is not important. There was also a view that applicants did not understand the supporting information guidance and that this also contributed to them not submitting any.

"I think they just don't know what it means… and you've called them to say… I'm just looking to know what support it is that you need [around supporting information]. "I just didn't know what to send" …and then they are like, right, okay, I can get that, I just wasn't sure what was actually meant by it. I feel as if they don't have a proper understanding of what is actually meant by supporting information and I think this is why we get so many cases that don't have any on it".

(CDP Case Manager)

This point is in keeping with the finding that applicants had very mixed levels of understanding of what supporting information to submit (see Chapter 2, Views on the purpose of supporting information and where it should come from).

Challenges with the supporting information provided by applicants

Case Managers were asked what the main challenges were relating to the supporting information that applicants provide. Contradictory information was one issue mentioned, as it requires some further checking, for example if the supporting information and application form say different things about a person's mobility needs. A further challenge was the lack of detail given around specific points such as how long someone can walk for, or how much help and attention a child needs in the night. This was an issue in supporting information from both professionals and individuals' wider support networks. Case Managers said they were not aiming to gather supporting information on every aspect of an individual's life, however, specific details were sometimes required to decide what level of benefit to award.

Further problems with supporting information sent by applicants included:

• Only part of a document being uploaded.
• Blurry images of documents.
• Documents not being on headed paper when from a professional (which they would then follow up by calling the professional).
• Photographs of the applicant or child to show their condition (which at the time of the interviews could not be used).

Staff were familiar with the barriers some applicants face in providing supporting information. CDP Case Managers said it can be particularly hard to obtain supporting information for Care Experienced children, especially if they have moved home several times. ADP Case Managers said they face the most challenges obtaining supporting information on an individual's behalf when someone has disengaged from health services and/or has severe mental health problems. It was mentioned by Decision Team Managers that not being able to contact individuals' wider support networks directly in this scenario is problematic: it may not be appropriate to phone the applicant or they may not have the mental capacity to understand why Social Security Scotland is asking permission to contact someone in their wider support network.

As mentioned in the section in Chapter 2 on Enablers to providing supporting information, some applicants received valuable support from charities when applying. However, ADP managers said that in one case, misinformation was being given out by an advocacy charity, advising applicants not to provide any supporting information with their applications as it was all to be obtained by Social Security Scotland, which indicates a misunderstanding of the policy commitment stating that Case Managers can gather supporting information on individuals' behalf, not that they must do in every case.

Issues with requesting supporting information from professionals

Requesting and obtaining supporting information from professionals was cited by staff as the main cause of delays in processing applications. Obtaining supporting information from GPs was described as especially difficult for a range of reasons:

• Not all GP surgeries use the 'inbox' part of the SCI Gateway system (a secure email system used to communicate with surgeries).
• Not all surgery staff know how to use SCI Gateway to respond to requests.
• Some surgeries refuse to respond to requests altogether.
• Others reply to say they do not hold the information needed.

These challenges were experienced most by ADP staff as they contact GPs more often. Operations Managers said they wanted to forge better relationships with GPs and the NHS in order to address the SCI Gateway issues and subsequent delays. CDP colleagues described similar delays when contacting NHS staff and delays in getting supporting information from local authorities. Reasons given for these delays were similar to those mentioned above in relation to GPs. CDP teams also noted that responses from schools could take a long time if they coincided with school holidays. While staff were aware of the pressures that those in the NHS and other parts of the public sector were under, they also called for a review of the way requests were dealt with because of the delays caused for individuals in need.

Case Managers agreed that the speed of response varies by geographical location, saying that some GP surgeries, local authorities, and health boards are quicker to reply than others. Some teams kept track of which GP surgeries had been repeatedly unable or unwilling to reply to requests within the agreed timescales. This is to help Case Managers decide the best route for obtaining supporting information i.e., not relying on replies from these surgeries.

"It's not like an official thing, it is where you send out a request to the GP and they just refuse to give information basically, so then you note that that particular GP [is] not as cooperative… you should still send out the request, but the likelihood of you getting the answer back is pretty minimal. Which shouldn't really happen to be honest, because they do have a…or so it has been said that they do have an obligation to actually answer it, because it is in the client's best interest."

(ADP Case Manager)

Staff explained that there was considerable variation in the level of detail in supporting information received from professionals. One Decision Team Manager said some health boards would send a five-page report enabling a decision straight away, whereas others would provide nothing that adds to what they already know. This may be related to the point above about being able to ask the most pertinent questions for each case.

Systems and processes within Social Security Scotland

Operations Managers spoke positively about what has been achieved overall in terms of processes and systems in a short space of time since ADP and CDP were launched, particularly given the scale of the task. The high levels of applicant satisfaction with the supporting information process (discussed in Chapter 2) bears this out.

However, Operations Managers also conceded that there was still much to do to improve processes and that there are still a lot of 'workarounds' because the systems do not currently do everything they need.

"I think we have done a huge amount of work in a short space of time, landing a benefit which is the biggest benefit the Social Security have ever undertaken. We're replacing an existing benefit from an organisation that is one of the biggest national employers in the country, but we are managing to do that and we are on a constant learning curve, but we are striving to get better and more efficient…one of the key phrases was 'we don't know what we don't know', and we're finding out things, but the overall mentality within the agency is [to do] the best we can."

(Operations Manager)

The specifics of the 'workarounds' were not explored in detail, but the main system-related issues raised by staff are covered below.

CDP Case Managers explained that they are limited in the questions they can ask when requesting supporting information from professionals. They are required to choose questions from a drop-down menu. Being unable to write their own questions means they often do not receive the exact information back from professionals that would aid their decision making. ADP Case Managers said they do not use many of the pre-written questions, but there is a free text box that allows them to fully articulate what information they require. CDP Case Managers were frustrated with this part of the process of obtaining supporting information because it hinders them finding out precisely what they would like to know. This could then cause further delays to the decision-making process, something which applicants have indicated is their main source of dissatisfaction.

A further issue raised was that, due to a limited number of licences being available, most Case Managers were unable to access the software used for requesting information from health boards' 'front door teams' who manage requests for information from outside the NHS and from local authorities. CDP Case Managers said this made obtaining supporting information more arduous because, to use this system, they need to put an internal request in to a colleague and they cannot check the status of a request themselves. This caused further delays in the decision-making process.

Client Support Advisors working in local delivery were very clear that the main process issue for them was struggling to photograph supporting information using their work laptops. While they do have work phones and tablets, they currently do not allow for photos to be taken and uploaded securely from them. They suggested that better tablets or phones would save time and make the process easier for them and for applicants, and avoid blurry or partial documents accidentally being uploaded.

Case Managers viewed the input of Practitioners through the case discussion process as very valuable – often because their medical opinion could enable a decision to be made when little or no supporting information had been obtained. However, they added that the general lack of supporting information had driven up demand for Practitioners' time, and it could be a three-week wait before they were available to help with a decision.

Impact of Covid-19 on obtaining supporting information

The Covid-19 pandemic was thought to have had some indirect impacts on the gathering of supporting information. Staff perceived the NHS and other frontline services to be overstretched, having not fully recovered from the pressures they faced during the pandemic, and they thought this exacerbated delays in responding to requests. CDP staff mentioned the large numbers of children that are yet to be diagnosed as they are on waiting lists for Child and Adolescent Mental Health Services (CAMHS). They explained that these are already long waiting lists which have lengthened further because of the pandemic. This had the impact of more CDP applications being made prior to being seen by CAMHS, increasing the need to gather supporting information from teachers or other professionals who have been supporting the child.

From an applicant perspective, difficulties in obtaining a GP appointment, again exacerbated by the pandemic, caused some challenges. This was the case for two of the unsuccessful applicants in particular – see Chapter 2 Unsuccessful applicants and supporting information.

One of the successful CDP applicants, who initially had difficulty obtaining supporting information, pointed out that his young son had not been seen by family or friends while Covid restrictions were in place, so supporting information from his wider support network was not an option.