Devolved disability benefits: decision making – commissioned research report - annex A

3 Conclusions and recommendations

3.1 Conclusions

Clients’ perceptions of decision-making are mixed in relation to most of the intended outcomes, with their experience of the outcomes sometimes being correlated with whether their payment outcome was successful or unsuccessful. Positively, however, clients’ feedback suggests that many aspects of decision-making are delivering on the intended outcomes at least some of the time.

Given that clients do not always receive their hoped-for outcome, the decision letter’s explanation of how the decision was reached is of great importance in helping the client feel heard and understood and giving them confidence that their decision was unbiased and accurate.

Staff are confident they use a range of information sources and internal decision-making tools and resources to understand the client’s situation and reach an accurate and unbiased decision while avoiding burdening the client with unnecessary contact. However, there is evidence that Case Managers worry about the risk that the information, tools and resources can sometimes result in a discussion that focusses on conditions more than the impacts on the client as an individual, or used to query the client’s account; and some clients were concerned that the decision letter they received suggested that Social Security Scotland took receiving treatment as indicating a condition would improve or took being in work as evidence a condition was not that severe. There is also evidence of an appetite amongst clients to provide more supporting information or to explain their situation fully through a dialogue with Social Security Scotland.

The ADP application form is felt to be more restrictive and ‘one-size-fits-all’, making it more difficult for some clients to explain the impacts of their condition(s).

There is general agreement that reviews are conducted in a way that seeks to avoid burdening the client with unnecessary requests for additional information, however it is also apparent that the review process is not always fully understood by clients and does not always provide Case Managers with a comprehensive enough update on the client’s situation.

Among those who had a consultation, there was an agreement among clients and staff that it was person-centred and gave clients the opportunity to share how their condition was impacting them. Some staff did think they could be less formal. Also, some clients who did not have a consultation would have liked an opportunity to discuss their situation with Social Security Scotland staff.

Clients reflected more positively on review periods when they felt that the reasoning for these was explained clearly to them in the decision letter. However, clients who felt it was not explained clearly, wanted more reassurance that assumptions on their health had not been made.

Clients’ trust that decision-making is fair and accurate is sometimes undermined by their perception that additional supporting information had not been collected from the contacts they had provided. In these cases, it is likely that case managers felt they already had enough supporting information to make a robust decision.

The client’s relationship with Social Security Scotland is sometimes undermined by a lack of progress updates on the status of their application or review during the process; and this causes clients stress and uncertainty.

Alongside the lack of updates, long timescales to reach decisions sometimes caused clients uncertainty and stress.

3.2 Recommendations

1. Ensure decision letters consistently describe what information was used and how, for each decision element.

2. Consider how to ensure Case Managers are using decision-making tools to make an accurate decision but not to query the impact of the client’s account of their condition. Furthermore, Case Managers should maintain that the tools can be used for understanding conditions in more depth as well as for understanding and drawing on the impacts of those conditions based on the information the client has shared with them. This might include the use of ‘drop-in sessions’ for Case Managers to engage with colleagues (e.g. Decision Support Staff), consistency calls or feedback sessions. This was suggested by staff as a possible refinement.

3. Explore whether there is an opportunity to enable more informal dialogue between the client and Social Security Scotland (including Practitioners, where appropriate) as a way for clients to explain their situation more fully. This may particularly apply to those with complex, fluctuating or non-physical conditions. This was suggested by clients and staff as a possible refinement.

4. Revisit the guidance provided to clients about the types of information to provide in a review, to improve clarity for clients and generate more of the information required by Case Managers. This should include clarification of what information to provide about circumstances where the client believes there is ‘no change’, which particularly caused confusion for some clients.

5. In addition, given that clients did not always realise that Social Security Scotland were using information from previous decisions when conducting reviews, consideration should be given to including in the review pack for clients, wording stating that Social Security Scotland will be using existing information held on the case where still relevant to inform their review decision. This was suggested by clients and staff as a possible refinement.

6. Greater clarity should be given to clients that Social Security Scotland only gathers as much supporting information as is needed to reach a robust decision.

7. Consider staff ideas for supporting decision-making through closer working between Case Managers and Practitioners – for instance, a process for Case Managers to ask ‘quick questions’; or more Case Manager guidance on requesting case discussions and consultations.

8. Consider raising awareness for clients that they can request a consultation as part of the decision-making process when they apply or undergo a review.