Disagreement over scores in NHS Continuing Healthcare care domains – what to do

Disagreement over scores in NHS Continuing Healthcare care domains – what to do

Disagreement over scores in NHS Continuing Healthcare care domains - ticklistWhat 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. 18: Deteriorating health needs and NHS Continuing Healthcare

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.

What re the NHS Continuing Healthcare assessment guidelines?

What are the stages of the NHS Continuing Healthcare assessment process?

Why are elderly people often wrongly charged for care?


  1. Gill 2 months ago

    Similar experience except we were effectively barred from the Decision Support Tool meeting despite requesting to be present …called an unfortunate oversight! We said Behaviour should be assessed to be at the highest level due to incidents at home putting mum and sleepover Carers at risk. They said there was no evidence of these incidents in the care home …(.reason the incidents were being managed as she had no access to danger) and mum was put into a care home on the recommendation of the community mental health nurse. 7 years later we have finally met someone face to face. The argument continues. These people will learn if people like us with the help of this excellent website continue to battle.

    • Angela Sherman 2 months ago

      Thanks for your kind feedback on the website, Gill.

  2. Lucy 2 months ago

    This is exactly what happened in my grandmother’s Decision Support Tool meeting. I quoted the NHS Continuing Healthcare guidelines a number of times, only to be ignored. Despite repeated disagreements between the lead assessor of the CCG and the Social Worker, no higher domain was recorded. Now we’ve got the final report back, the domains have been scored even lower by a CCG representative who didn’t even attend the DST.

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