Show confidence during the NHS Continuing Healthcare assessment process
Are you feeling daunted at the prospect of an NHS Continuing Healthcare assessment for your relative? Not sure how to handle the questions and statements you may hear from the assessors?
As the many comments from families on our website show, the Continuing Healthcare process is not always easy. Indeed, it can often be adversarial.
Being well prepared and as well informed as you can be in advance can help a lot.
11 tips to help you stay confident and stand your ground in NHS Continuing Healthcare
1. Know the guidelines
Read the NHS Continuing Healthcare assessment guidelines – most importantly the Checklist, the Decision Support Tool and the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Get familiar with how things should be done, and keep detailed notes on anything that has not been done correctly so far. Make sure you also understand the different stages of the assessment and appeal process.
2. Know your position
Familiarise yourself with the eligibility criteria in the Checklist and the Decision Support Tool. Make sure you know what scores your relative should genuinely receive and what the outcome should be. If anyone tries to trivialise your relative’s needs during an assessment, counter it immediately and make sure your objection is written in the assessment notes.
3. Gather evidence
This is the job of the assessment team; however, you also need to be proactive here. Make sure you look in advance at the daily care notes and the care plan from the care provider/care home. Make sure the contents are both comprehensive and accurate. If they’re not, complain to the care provider, and also make sure the NHS Continuing Healthcare assessors are aware that the notes are inadequate and/or misleading. If your relative sees other specialists, clinicians, therapists, etc., get hold of their evidence concerning your relative’s care needs and risks. This could, for example, be a letter from each one summarising your relative’s health and care needs. BUT – and this is really important – make sure you explain to them why such evidence is needed, otherwise they may write something that is not fit for the Continuing Healthcare process and that may inadvertently play down your relative’s needs.
4. Gauge the assessor’s position
Assessors may have been thrown in the deep end and told to carry out an assessment with very little, if any, training in the Continuing Healthcare process and in care funding law. Never assume the assessor knows more than you. If you follow the first three steps here, you may know more than they do. For this reason, never simply assume that what an assessor tells you is correct. You’ll know whether it is or not from all your reading, and from reading this website. Other assessors may be more experienced in the Continuing Healthcare process, and yet time and time again we hear of flawed practice by assessors who seem intent on denying funding regardless.
5. Be open
If you’re going to record the meeting, tell the assessors you’re going to do so. And then record it. It protects everyone in the room to have a word-for-word account, and there can then be no dispute about who said what.
6. Take the lead
Tell the assessors what you expect, i.e. that you expect the assessment to be carried out according to ALL established guidelines, in line with ALL relevant case law and in line with ALL relevant care funding legislation. Make sure the assessors are under no illusion that you are well informed and aware of the rules.
7. Interview the assessors
Ask each assessor in the room what his or her role is in your relative’s assessment process. Also ask them why they are at this particular meeting and what experience they have in Continuing Healthcare assessments and, most importantly, how well they know the person they are assessing, i.e. your relative. You have every right to know who everyone is and why they are there.
8. Ask for clarification and reference points
Whenever an assessor makes an assumption, makes a statement or says something you disagree with, ask for clarification. Ask them for the evidence or a reference that supports what they are saying. For example, if an assessor dismisses the Coughlan case, ask them immediately where exactly in the guidelines it says that this landmark legal case is not relevant. In this particular example, they won’t be able to. Do this for every point you disagree with. (There may of course be instances where the assessor is correct, but stay on your toes so that nothing slips through that wrongly undermines your case.)
9. Take someone with you
This is good for moral support, even if your friend or supporter doesn’t know all that much about Continuing Healthcare. An extra pair of ears and eyes, and someone else to make notes is a valuable thing. The person you take with you can also ask questions. Out of courtesy, and to avoid any arguments at the start of the meeting, let the assessors know in advance who is coming with you.
10. Stay calm
Even if you don’t feel like it, it helps to maintain a calm and businesslike demeanor throughout. Keep your body language and posture confident too. It can be very hard when you’re having to talk formally about someone you love, especially if they are at the end of their life; keep going as best you can.
11. Drink water
Keep drinking water throughout, to keep yourself alert and refreshed.
You’ll find lots more tips and advice about NHS Continuing Healthcare assessments in our book, How To Get The NHS To Pay For Care.
Do you have any additional tips that cold help someone in an NHS Continuing Healthcare assessment?