How NHS Continuing Healthcare assessors are rewriting the dictionary

How NHS Continuing Healthcare assessors are rewriting the dictionary

3 words the NHS has redefined

dictionary booksAnyone with a relative receiving full time care and who has been through an NHS Continuing Healthcare funding assessment will almost certainly have noticed how the language used in assessment notes can be misleading – to say the least.

It seems that NHS Continuing Healthcare assessors are rewriting the dictionary now – and actually changing the meaning of words.

Many families report that assessors’ comments and notes deliberately use words that play down health needs, with the result (of course) that the person being assessed is found ‘ineligible’ for funding.

Not only is this exasperating for families, who are then forced to appeal, but it would seem a sinister and cynical attempt to stop people receiving the NHS care they are entitled to.

Not only do we hear of NHS assessors choosing words to manipulate funding outcomes, but it seems some are now also changing the actual meaning of words and phrases in the English language.

The following are real examples of things that have been said and done in Continuing Care assessments.

3 words to watch out for:

1. ‘Unpredictable’

Usual definition: Not capable of being predicted; changeable.

One of the things Continuing Care assessors look for are health needs and risks that are unpredictable, for example a high risk of falls, aggressive behaviour that could be a danger to the person or to others, a risk of choking, etc. We have recently heard two separate instances of the meaning of this word being completely twisted. In seems that (according to the NHS) if health needs are indeed unpredictable, then that unpredictability is likely to be quite predictable! In other words, care staff know the person’s needs are unpredictable – and so these predictably unpredictable needs don’t count. No problem. No funding. It’s absolutely ludicrous.

2. ‘Incontinent’

Usual definition: Lacking in control over urination and/or defecation.

Here’s another account we heard recently. Someone who is incontinent will usually wear continence pads and yet care staff may also sit that person on the toilet from time to time, just in case they need to go at that point in time. It seems that if a carer does take someone to the toilet, and manages to do this before the person has actually soiled their incontinence pad, a miracle has occurred: the person is declared fully continent! And this is what gets written in the assessment notes. No problem. No funding.

Never mind the fact that regardless of what carers may do, the person still has little or no control over their bladder and/or bowel and still needs intense care to manage that. It’s a hideous abuse of power for assessors to manipulate the meaning like this.

3. ‘Malnutrition’

Usual definition: Lack of adequate nutrition resulting from insufficient food, unbalanced diet or poor absorption of nutrients.

There are various reasons why a person in care may not be able to eat very much and/or is losing weight: Dysphagia and difficulty swallowing is one, severe dementia is another, problems with the small intestine or bowel, certain medication and poor care home food are others.

If a person is malnourished, whatever the reason, this is of course a very serious matter. The care plan and care notes for that person may state that they have just a few spoonfuls of food for a meal – but that (and here’s the crucial thing) they finish those few spoonfuls. Hey presto – they’ve finished their meal! They’ve ‘done really well today’ – and the funding assessment notes will often then conclude that the person has a good appetite. All is well then. No problem. No funding. If it weren’t so serious, it would be laughable.

Budgetary considerations should never be part of Continuing Care assessments

The way these things are done can be quite insidious, because when you’re sitting in an assessment and the people in the room are all nodding that everything’s fine and that your relative doesn’t really have any needs that require NHS funding, it can be so difficult to know what to say on the spot. You know it’s not right, and you may feel stunned by what you’ve heard the assessors say, but what’s happening is just so unbelievable that you often just can’t find the words to argue back – and so you’re left wondering How To Get The NHS To Pay For Care – e-book.

Of course, this behaviour by assessors is completely unacceptable – and it’s no doubt down to budgetary motivations and perhaps some pressure they may find themselves under to deny funding. And yet this should never, ever, be part of an NHS Continuing Healthcare assessment.

The whole situation leaves families angry and exhausted, especially when it’s seems that assessors are hiding behind false officialdom and contrived measures to protect their own budgets.

Have you noticed other instances of words being twisted in assessments to prevent funding being approved?


  1. Gill 2 years ago

    At our son’s Checklist meeting the nurse assessor told us ‘unpredictable’ meant a person kept displaying new and different challenging behaviours, so that care staff could not predict what they were going to do next. She said it did not apply to a situation where a person has sudden, unpredictable outbursts of challenging behaviour – where care staff have to watch them all the time because they cannot predict when the person will flip – unless they keep coming up with NEW challenging behaviours. She said the ‘unpredictability’ applied to the nature of the challenging behaviour rather than the timing. She gave an example of a person with dementia who might develop new challenging behaviours as their condition progresses. Surely this cannot be correct? We have our son’s Multidisciplinary Team meeting coming up and I would like to know how we argue against this interpretation. Is there anything we can quote from any guidelines or notes or cases?

  2. Anne wilson 4 years ago

    My husband’s first assessment was carried out in June 2015 and the last in October 2015. Another two carried out between these dates. In early January 2016 a letter was written to my husbandat his Care Home stating that he would be receiving funding. Letters were also written to the Manager one explaining how much was being paid and stating this was being back dated to October. At no time throughout all of this have I received any correspondence. The Care Home have now been notified that a further assessment will be carried out as the powers that be want the funding stopped as my husband does not require nursing care! His behaviour is unpredictable and he is incontinent etc etc. I would be grateful of your comments.

    • Angela Sherman 4 years ago

      If you are effectively acting for your husband, Anne, you should have been kept full informed all the way through. There is a three-month review after a person has been awarded Continuing Healthcare (CHC), but funding should only be removed if underlying care needs have genuinely reduced below the eligibility criteria. We hear from many people whose funding has been removed as a matter of course – without a properly conducted review. Make sure you attend the review meeting.

  3. Lottie 5 years ago

    Mother has been put on anti-psychotics and anti-depressants due to paranoid and aggressive behaviour. Assessor said her needs have now stabilised! Quelle surprise?
    Managed need re-defined – job done!

  4. Ray Salmon 6 years ago

    I have read all of the above and we are in the same situation, my uncle is 88, he has just been admitted into a nursing home, he has to be hoisted everywhere, fed his two spoonfuls at each meal, has a thickener in his drinks in case he chokes, and is totally incontinent. He has lost half his body weight.
    But when we visit him we are told ” he’s had a good day today “.
    His £22,000 lifetime savings are being used for his care fees and now we have to sell his house which has made him very depressed.
    He fought for this country as a sergeant major in the Burma jungle, has worked all of his life and paid his taxes etc and now he thinks why is he losing everything he has worked for.

    • Angela 6 years ago

      Thanks for your comment Ray. The system certainly can seem very unfair, and of course with many funding assessments not being done properly, it makes things even worse.

  5. Lesley Kemp 6 years ago

    I don’t get it – my father is home alone, now not letting carers in, food supplies low. I have grumbled to Social Services, his GP, MP, Uncle Tom Cobly and all to no avail. Feel so helpless. Only a couple of weeks back while he was in hospital, he was assessed as not having capacity and then that was overturned and he was discharged back to his home. It’s not just words they twist around, it’s everything! I give up!

    • Angela 6 years ago

      It’s exasperating, isn’t it? And I think you’re right, Lesley, that so many things get twisted to suit different agendas. If someone refuses care and lack capacity, there my be a case for neglect on the part of the authorities if they don’t act. Have they provided a written account of why they think your father does now have capacity? If you’re not already familiar with the Mental Capacity Act, it might be worth checking it out. We’ll be featuring something about it in this month’s newsletter.

      • Lesley Kemp 6 years ago

        Thanks for your advice Angela. I didn’t realise I could ask for a written account. The system has let my father down badly and at the moment I am trying to keep everyone fired up and engaged with my his needs. Just keeping my fingers crossed that he doesn’t fall over and kill himself while the professionals are running around in circles chasing their tales. 🙁

        • Angela 6 years ago

          Hi Lesley – by written account I mean that something somewhere should document the reason for their decision that your father has capacity, and/or it should show in black and white how the health/social care people reached that conclusion and what process they used. It may have been a Mental Capacity Assessment, in which case there should be some written evidence of that.

  6. Angela Rhodes 6 years ago

    Excellent article Angela reflecting exactly my own experience with “unpredictable” and “incontinent”. The assessor waited until everyone else was out of the room and told me that the NHS wasn’t a bottomless pit and didn’t have the resources to fund everyone who needed care”. I felt under extreme pressure to withdraw the claim.

    • Angela 6 years ago

      Thanks for your comment, Angela. The comments of the NHS assessor are yet another example of how the whole thing is motivated by budgets, and how assessors seem to be willing to do and say almost anything to protect them – no matter how absurd.

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