Social Security Experience Panels: award duration and automatic entitlement

Automatic Entitlement

Automatic entitlement is where people with particular disabilities are entitled to a benefit award without having to undergo a face-to-face health assessment or provide any further information beyond confirmation of their diagnosis with an elgiible condition. Automatic entitlement could reduce the stress experienced by individuals applying for benefits and help the agency reduce the volume of health assessments carried out for disability benefits, whether face-to-face or otherwise.

This is a change from the current system where for some disability benefits (for example, Personal Independence Payment) the decision is based on the extent to which the disability affects the client's day to day life. This is determined through a health assessment which the applicant is required to attend as part of the application process.

It is expected that automatic entitlement to disability benefits for some conditions would benefit those who have lifelong conditions.

Should certain conditions qualify people for automatic entitlement?

Participants were asked whether people with certain conditions should be automatically entitled to disability benefits. Four in five participants (80 per cent) believed this should be the case, with ten per cent of participants disagreeing with the idea and ten per cent uncertain.

Table 8: Should people with certain conditions be automatically entitled to disability benefits (n=241)

Response	(%)
Yes	80
No	10
Don't know / not sure	10
Total	100

Some participants believed that those whose medical condition would not change or improve over a long period of time should not have to undergo repeated assessments.

"Because there are certain lifetime conditions that are never going to improve or be cured, so why put people through unnecessary assessments when they will never get better. All this does is add even more stress and this in turn exacerbates the illnesses that people are already coping with."
- Survey participant

The level of stress and anxiety caused by assessments contributed to participants wanting to only be assessed when absolutely necessary:

"…life is hard enough without having to sit in front of strangers answering questions…"
- Survey participant

Other participants said that for long term conditions it could often be difficult to provide up to date evidence from a GP or consultant. This is because many participants were now at the stage of managing their condition rather than actively seeking treatment for it. These participants saw their health professionals on a very infrequent basis and were reluctant to 'waste' their doctors time by making an appointment solely to ask the doctor to provide an updated report on their condition.

What conditions should qualify someone for automatic entitlement?

When asked what conditions should qualify, participants tended to talk in broad terms rather than about specific conditions. The most common conditions mentioned were:

• Terminal conditions
• Learning disabilities
• Autism
• Cognitive disorders
• Chronic conditions
• Progressive conditions

Participants believed that assessing people with these conditions was hard to justify:

"Certain conditions are progressive so are only going to get worse not better. If a medical diagnosis of such conditions has been confirmed benefits should be automatic."

"People who are coming to terms with life limiting conditions should not have to jump through hoops to get financial assistance."

"There is no cure, so why can she not get a lifetime award"
- Survey participants

There was less consensus on whether mental illnesses should qualify for automatic entitlement.

Some participants believed that variations in the severity of mental illness between different individuals made them unsuitable for automatic entitlement or would be difficult to assess. Some believed it was important to recognise the difference between those who had a repeated history of severe mental illness and those who were undergoing a severe, but short-term episode.

To address the issues with automatic entitlement and mental illness, some participants suggested Social Security Scotland base the decision on a discussion with psychiatrists as to whether an individual's condition was severe enough to qualify (although this is not automatic entitlement in the strictest sense as there is still some level of assessment involved). Others believed the length of time the individual had been diagnosed with the condition should be taken into account. This would aid in distinguishing between those who had a long history of mental illness and those who did not.

Who should decide who is automatically entitled

Participants were asked who they thought should decide which conditions should qualify for automatic entitlement. Both survey and focus group participants were given the same list of options, and both groups were allowed to suggest other ideas.

Survey participants were asked to choose all options they felt comfortable with. More than eight in ten survey participants (84 per cent) said they would be comfortable with doctors or other health professionals deciding which conditions qualify for automatic entitlement, and just under two fifths (39 per cent) of participants were comfortable with an independent group of advisors. Thirty-seven per cent were comfortable with Social Security Scotland deciding.

Table 9: Who should decide what conditions qualify for automatic entitlement (n=241)

Response	(%)
Doctors or other health professionals	84
An independent group of advisors	39
Social Security Scotland	37

Sixteen per cent of survey participants selected 'Someone else' and were given the option of telling us who. Suggestions included:

• A panel of disabled people
• Disability organisations
• A panel of healthcare professionals

There was little consensus amongst focus group participants on who should make the decision. Most participants believed that many of the suggested options were viable, emphasising that the most important requirement was the person or people deciding had a medical background and a good understanding of disabilities.

Participants were asked how they would feel if Social Security Scotland made the decision. Most participants did not believe this would be an issue, however some disagreed. Those who disagreed said they would prefer the decision maker to be independent from the agency.

Identifying those who are automatically entitled

Participants were asked if they could think of any ways that Social Security Scotland could identify those who may be automatically entitled before they apply.

Responses tended to fall into three groups: enhanced data sharing between the NHS and government, an improved application form and referrals from third parties.

A number of participants suggested that a health professional could signpost a patient to the Agency once they had been diagnosed with a qualifying condition. Others believed a letter or report from a GP to Social Security Scotland should suffice or that the client's health records could be sent to the Agency.

In terms of the application form itself, many suggested a tick-box with a list of qualifying conditions at the start of the form.

The most common suggestions usually referred to data sharing between the Agency and the NHS, allowing for quick identification and verification of those who had been given a diagnosis of a qualifying condition.