How assessors play down health needs in Continuing Healthcare assessments – more examples

How assessors play down health needs in Continuing Healthcare assessments – more examples

Do your relative’s assessment notes contain these phrases…

Searching for TruthOne of the biggest gripes families have about NHS Continuing Healthcare assessments and outcomes is that assessors are often looking at very poor quality daily care notes – notes that often do not take account of the key issues that needs to be assessed in a Continuing Healthcare assessment.

It’s a ludicrous situation, and it plays straight into the hands of those assessors who apply misplaced budgetary filters to decisions about a person’s eligibility for funding. Such a decision is supposed to be purely about health needs and specifically not about budgets.

However many families also feel that assessors deliberately play down health needs in Continuing Healthcare assessments.

It’s common for assessors to be highly selective about which statements from daily care notes they actually take account of – and many families feel that assessors paint an unduly rosy picture of a relative being assessed in order to declare them ineligible for funding.

Here’s an example…

In a full assessment, a person with severe dementia or serious mobility problems, for example, may be described in the assessment notes as “needing assistance with” things like continence, eating, etc – because they cannot do anything for themselves.

However, using the words “needing assistance” implies that the person is able to manage, and just needs a bit of help here and there – when in fact the truth of the matter could be that the person is entirely dependent, wholly vulnerable and needs full care intervention!

So if you’ve been sent a copy of your relative’s assessment notes and you see the words “needs assistance with” in them, challenge this (if it’s relevant to your relative). Make the point that your relative is completely dependent and does not simply need ‘assistance with’. On the contrary, they need ‘full intervention’, ‘full management of their care needs at all times’, they are ‘100% dependent’ and ‘extremely vulnerable’ – whatever is appropriate.

Another example that you may see in the assessment notes about your relative is that “staff need to monitor him/her” or “observe”. In the case of someone who is at serious risk of dehydration because they cannot drink anything by themselves, such wording in the assessment notes implies the opposite – and that staff just need to keep an eye on the person now and again. It implies there isn’t really a health need here.

So if you see instances of these words in your relative’s assessment notes, challenge the assessors about it and insist that the wording properly reflects the real situation.

You may also need to take up the issue of poor daily care notes with the care home – so that they represent a true picture of the day-to-day health and care needs and risks for your relative.

Check the language used in Continuing Healthcare assessments.

Do you have other examples of language being used to play down care needs?


  1. Andrew Bundy 2 years ago

    I found in my review Decision Support Tool (DST), which was a very fraught exercise even for someone of reasonable education that I had to argue between assessment levels on the proper use of the English Language. In two or three domains, the difference between moderate and severe is often found solely in the placement of ‘or’, ‘and’ and in my most contested domain (which I won through on) a single comma.

    You really DO need to carefully understand, in advance, for each domain how the scores are arrived at. Obtain a copy of the form in advance, and study the descriptors. Make notes to justify how your own evidence would justify a particular descriptor in each domain. This will give you a position to argue from (or appeal from later). Better informed is Better prepared.

    It is quite possible that a relative or the service user themselves may have to argue a domain based not only on the evidence and views of the assessors BUT how they are applying their views against the descriptors in each domain. While scoring is not everything, you need to achieve a certain level to pass through, and every extra level in descriptor you can achieve could well make the difference, either at your initial assessment or if, like me, you are unfairly subjected to an unnecessary annual re-assessment through the Multidisciplinary Team (MDT)/DST process.

    In my assessment, there was a lot of debate over the meaning of the descriptors, even though we had a dedicated ‘moderator’ matron supposedly an expert in MDT/DST assessments. Most domains, with my evidence, were clear, but two or three were difficult, which is why I now firmly believe in having advanced understanding of the descriptors.

  2. Angela 7 years ago

    Peter – seen quite a few instances where assessors have looked at the descriptions of the lowest scores and tried to ‘match’ them to the person’s needs, instead of looking at the more appropriate higher scores. It’s a cynical attempt to protect budgets.

  3. Peter Couch 7 years ago

    It was also my experience that assesors deliberatly played down care needs, ignoring the fact that the scoring system was an UPWARDS scoring system. It was also my experience that social workers and nurses would keep quiet when one of their own group was speaking then talk accross anyone who tried to respond. I suggest getting a good quality voice recorder or covert video recorder to catch those who abuse carers.

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