Once your relative passes the initial Checklist stage for NHS Continuing Healthcare, (CHC) you need to start preparing for the full assessment at a Multi-Disciplinary Team Meeting (MDT).
Good preparation is critical.
Don’t be naive and turn up expecting the NHS Assessors to bend over backwards to assist your relative in getting funding for CHC. On the contrary, whilst the assessment should be carried out fairly, it can often amount to nothing more than a ‘tick box’ exercise for the CHC Assessors, going through the motions, before recommending that CHC funding is rejected. Read our recent blog: Don’t let the Decision Support Tool become a ‘tick box’ exercise
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised 2018) sets out who can attend the MDT. The MDT must be carried out by a Multi-Disciplinary Team i.e not just one person, but at least two professionals, one from healthcare and the other from social care. Hopefully, there will be a minimum of at least two people involved, as the assessors need to draw on all the evidence about your relative’s health and care needs from all those involved in their daily care. Generally speaking, the more people involved, the better, as that will give a wider reflection of your relative’s overall healthcare needs.
The MDT should comprise of people who have been trained in the NHS National Framework and have direct knowledge of your relative’s health and care needs. If they do not, then it is a pointless exercise and the assessment is likely to be meaningless and a waste of time. You must be satisfied that the CHC Assessors have had some input into your relative’s care. If not, question what they are doing there and what value they can add to the assessment process. If you are dissatisfied, make sure a record is made in writing as this may give you grounds for appeal if the outcome goes against you.
Check what experience your CHC Assessors have of the CHC assessment process, and ask how many previous assessments they have been involved in. Don’t be surprised if this is their first MDT.
If the assessment date given for the MDT is not convenient, say so. Ask for a different date to be provided when you can attend and/or have adequate time to make your preparations in advance.
If an assessment takes place without your input, you can object. You have 6 months to appeal and should claim that there has been an abuse of process. However, you may then go back in the queue, waiting an inordinate time for an appeal to be convened.
Be aware that care home staff may be helpful but equally unhelpful to your claim for CHC Funding. The CCG Assessors may ask to undertake a preliminary fact find in advance of the MDT without your knowledge, and ask care staff about your relative’s condition. There is a risk that the staff representatives may underplay their healthcare needs, or put a more positive ‘spin’ on the situation, painting a better picture than is really the case. For example, comments such as ‘Bill’s had a good week,’ or’ Annie’s fine today’ – are meaningless, but could be used by the CCG Assessors to score a lesser level of needs.
Try and get to the MDT in plenty of time. See if you can speak to the care staff involved in advance and warn them to choose their words carefully and accurately, so as not to give a misleading impression of your relative’s needs.
Even if you are there early, make sure that you are in on the assessment meeting when it starts. It has happened that relatives have been waiting for the assessment to take place and they have been ‘bypassed’ and then notified of the outcome afterwards. So, insist you are at the MDT assessment when it occurs.
Make sure that you see the care plans, risk assessments and documentation and care records in advance and have an opportunity to study them and make any notes as to key areas. Don’t be surprised if the care home records are inaccurate, cursory and don’t truly reflect your relative’s day-to-day needs. Staff have many residents to look after and often notes are written up at the end of a shift, not contemporaneously – which can lead to confusion, mistakes, and merely a brief note with lots of missing vital details. The records are only as good as the person inputting the information, and that can prove detrimental to an individual with a high level of need.
It’s a good idea to find out in advance who is attending the assessment from the NHS Continuing Healthcare Team, so that you can see whether they are suitably qualified to be involved in the process, and whether representatives from any other disciplines ought to be included as well from the outset. You can also check whether those attending are, indeed, the people who you are expecting to see there.
Make sure that the assessors actually see your relative, because it can happen that this assessment is done in their absence.
If you get the impression that the assessment is a predetermined foregone conclusion, then object.
If you feel the CHC Assessors have not considered all the relevant material or given adequate weight to critical areas, then object.
Practice Guidance note 22 of The NHS National Framework (pages 116/117) lists the type of information/evidence that the MDT assessors should review prior to making their recommendations for eligibility for CHC funding – including:
Health needs assessment • Needs assessment (under the Care Act 2014) • Nursing assessment • Individual’s own views of their needs and desired outcomes • Person-centred plan • Carer’s views • Physiotherapy assessment • Behavioural assessment • Speech and Language Therapy (SALT) assessment • Occupational Therapy assessment • Care home/home support records • Current care plan • 24-hour/48-hour diary indicating needs and interventions (may need to be ‘good day’ and ‘bad day’ if fluctuating needs) • GP information • Specialist medical/nursing assessments (e.g. tissue viability nurse, respiratory nurse, dementia nurse, etc.) • Falls risk assessment • Standard scales (such as the Waterlow score) • Psychiatric/community psychiatric nurse assessments.
However, whilst these records are essential to the assessment process, it is your input that may prove the determining factor in whether your relative gets CHC Funding or not. Therefore, it is important that you are in attendance and are able to communicate clearly and effectively with the CHC Assessors, and supplement any additional information they have missed or areas which they have not grasped regarding your relative’s needs. Don’t assume that the CCG Assessors know everything about your relative or have suitably prepared for the MDT. You need to be alert to any gaps in their knowledge or misconceptions they may have as to your relative’s healthcare needs.
Experiences of Multi-Disciplinary Team Assessments (MDTs) can vary throughout the country, and unfortunately no two assessments are the same. Much can depend on the assessors’ background, knowledge and training on CHC assessments process and the NHS National Framework, and more particularly their personal knowledge of your relative and their healthcare needs, and how much time they have been able to spend in advance preparing for the assessment – including what records they have managed to see and information they have managed to obtain about your relative.
Sometimes this information or their knowledge will be quite superficial and their background knowledge cursory, giving an incomplete picture of your relative’s healthcare needs.
BEWARE! Some assessors may come with a pre-determined outcome in mind, and it can be hard to persuade them to the contrary that your relative’s needs meet the criteria for NHS Continuing Healthcare Funding. Of course, you will be in a better position because you will be familiar with your relative’s daily healthcare needs and will be able to point out any misunderstandings or misinformation which the CHC Assessors may have incorrectly assumed or believed about your relative’s healthcare needs.
Don’t get drawn into conversations about finances at this stage. The MDT assessment is not about how your relative’s care will be funded, but is simply to determine whether they have a ‘primary health need’ and are entitled to free funded NHS care for all their healthcare and accommodation needs. Finances do not and should not come into the conversation at this stage. It is supposed to be an impartial review of your relative’s healthcare needs – not their finances.
It is a good idea to take someone with you to the DST Meeting who can make notes or can contribute if they have any additional information to add.
Our Key Tips: Some basic Do’s and Don’ts!
From experience, families can get quite emotional, and are not adequately prepared in advance to deal with the pertinent key issues:
- Do plan ahead and think what you want to say in advance.
- Do stick to the key points you want to make.
- Don’t get side-tracked and can go ‘off piste’, waffling about care needs which are not relevant. This is a waste of valuable time, which will annoy the Assessors, and could detract from a good case, by shifting the emphasis on to any weaker arguments.
- Don’t become your relative’s own ‘worst’ enemy, by undermining their case, and giving the CCG ammunition to reject the claim for CHC funding.
- Be careful not to unwittingly make unhelpful comments which are detrimental to your relative’s chances of success. Know when to stop and ‘shut up’. Again, it’s all about preparation!
- Don’t sign your agreement to the DST. The MDT uses a Decision Support Tool (DST) to record the CCG Assessors’ level of need against each of the 12 Care Domains. There may be lots of issues, records or other evidence which the Assessors not have been considered as part of the assessment process and which could improve your relative’s chance of success. The CCG’s Assessors will complete the DST and know how they wish to record the evidence. A subtle use of language may not mean anything in particular to you, but could become a critical deciding factor in determining whether or not your relative gets CHC Funding. Effectively, therefore, by signing your agreement to the DST, you are accepting that the its contents are correct, and this could severely prejudice your chances if you need to appeal the decision. So, it’s not generally in your best interests to sign the DST.
A recent enquirer wrote into us about her experience saying, “The CHC DST was awful. The Lead Assessor who only met my Mum once, and relied totally on the care home notes, dismissed our evidence and some professional opinion, and read us her typed DST findings. She had huge gaps in the dates between evidence, and for those domains where she had no evidence from the care home, she marked ‘LOW’ even though we had lots of evidence!”
Naturally, our enquirer was disgusted with the way the CHC assessors had conducted this meeting and had pre-determined their thoughts in a typed DST with missing evidence. Even when they tried to correct that, and point out lots of other evidence which was missing, the assessors were apparently not interested. If this happens, you must appeal immediately. There is only a 6 month window to appeal once the decision from the CHC is handed down.
For further information, read our blogs about preparation for the MDT:
What Is The Role Of The MDT Coordinator?
Attending the Multi-Disciplinary Team meeting – some useful guidance
What Happens At The Multi-Disciplinary Team Meeting?
Can The MDT Panel Refuse To Proceed If I Have An Advocate?
Rejected for CHC Funding? Part 1: How To Appeal The MDT Decision
Share your experiences of attending an MDT below.
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Thank you for your reply. I was concerned at the Nurse Assessor’s ignorance of the National Framework and the fact that she hadn’t read the letter that my friend sent with comments on the Care Needs Portrayal. She is attending the MDT this week and will be party to the decision making process. How can she possibly do this with almost no understanding of the NF? Since the meeting we have prepared a DST which includes evidence from my friend and also references to nature, Complexity, intensity and unpredictability and reference to the Practice Guidance notes in the NF. I cannot see how they can refuse funding if they take note of the comments but this is a CCG that notoriously makes the rules up as they go along. The assessor confirmed that the family would not see the DST until ‘after the decision has been made but that (they) could appeal’ !! This department has consistently over the years shown that they have no empathy or understanding of what families go through nor indeed do they care. Thank you for your advice. I’ll post the result once it is known.
Having gone through the CHC process with my mother I am today attending a meeting as an advocate for a friend. The CCG are carrying out a retrospective CHC assessment because they cancelled several MDT meetings last year and my friend’s mother sadly died 2 days before the 4 th MDT meeting was convened. The CCG are saying that for retrospective reviews the deceased’s family is not entitled to attend the MDT. They have furnished my friend with a Needs Portrayal which is clearly flawed and biased in favour of the CCG. We have written a comprehensive challenge to the Needs Portrayal and insisted that the family attend the MDT. As a result the assessor is coming out for a discussion this afternoon. She has confirmed that she will not be bringing the DST but will transfer the evidence we give into the form for an MDT in camera. My friend will not see this DST and the decision will be made next week at the MDT. We are planning to insist that this afternoon we go through the DST and ensure that the family’s evidence is written on it with their recommendation for scores. If the CHC assessor refuses to allow us to do this can we insist that we attend the MDT next week as the NF makes it clear that families should be involved. Having looked at the scores on the DST it is clear that the deceased will score very highly in a number of domains. The Needs Portrayal not only prevents the family from seeing the scoring system but it is a seriously flawed document designed to intimidate and confuse families. Eg it describes how the deceased has ‘slowly lost some weight’ and actually produced weight recordings which, we worked out, meant that the deceased had lost over 19% of her body weight in a few months!! I am planning to insist on completing the domains on the DST, comment on each domain referring to the flaws in the Needs Portrayal and getting the family to write their comments about the Needs Portrayal in general on the DST including the fact that it makes no provision for Nature Complexity Severity or Unpredictability. Is there anything else I can do to help this family?
Hi Ali. It is usual practice for the CCG not to allow family members to attend the MDT meeting when dealing with retrospective cases as they will request family comments in the form of written submissions. We often find that the Needs Portrayal Documents are missing key information and we would advise you to obtain full copies of the care home and GP records to see what information is missing. Hopefully the CCG should fully consider your written comments when the MDT takes place next week and will take your comments into consideration when scoring each domain. Although you can’t insist on attending the DST meeting, you can provide your own comments on each of the scores for the panel to take into consideration.
If the panel do not find that the patient is eligible, we would be happy to discuss the next steps with you and to advise on appeal prospects. 0161 979 0430 Kind regards