What happens if assessors can’t agree on the scores in NHS Continuing Healthcare care domains?
No. 19 in our series of 27 top tips on NHS Continuing Healthcare…
In a full assessment for NHS Continuing Healthcare there should be a multidisciplinary team (MDT) discussing a person’s care needs.
It’s not unusual for members of that team to disagree over the individual scores in NHS Continuing Healthcare care domains.
So if that happens, what scores should actually be recorded?
(The care domains are the various aspects of a person’s health that are discussed in an NHS Continuing Healthcare assessment, e.g. Behaviour, Cognition, Mobility, etc.)
It’s very simple:
If the members of the assessment team cannot agree on the individual scores in NHS Continuing Healthcare care domains, the higher score should be awarded. This is the score that should be noted in the Decision Support Tool document.
This point is made very clear on page 77 of the National Framework guidelines. Paragraphs 35.1 to 35.3 include this statement:
“If practitioners are unable to reach agreement, the higher level should be accepted…”
For example, if the social worker believes the score in the Behaviour domain should be Severe, and yet the nurse assessor wants to record a lower score of Moderate, and if they cannot reach agreement, the score in the Behaviour domain must be Severe, i.e. the higher score.
The Decision Support Tool (DST) also makes this clear (page 13 paragraph 22):
“If… it proves difficult to decide or agree on the level, the MDT should choose the higher of the levels…”
What if you disagree with the scores in NHS Continuing Healthcare care domains?
You as your relative’s representative may disagree with a particular domain score. You’re entitled to voice your concerns and to argue your point.
Although the score you are arguing for may not actually be accepted by the assessment team on the day, your view should certainly be noted in writing on the Decision Support Tool document alongside the domain you disagree with.
Again, the National framework guidelines make this clear. See page 78, paragraph 36.1:
“…concerns expressed by individuals and representatives should be fully considered by reviewing the evidence provided. If areas of disagreement remain these should be recorded in the relevant parts of the DST.”
Always remember that a full assessment with a multidisciplinary team is just that: a team assessment; it is not for one person to decide what all the scores will be.
Despite that, families often report one CCG assessor dominating the meeting and imposing their own opinion/bias on the final scores. That is unacceptable. So if you find that one assessor is riding roughshod over other people’s professional views, and if there’s a disagreement about the scores or your own views are being ignored, quote the paragraphs above to the lead assessor.
Tip no. 20: Are there different levels of NHS care funding?
You don’t have to fight this battle alone
Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.