Great, so you have passed the initial Checklist Assessment stage and your relative’s claim has now been referred to a Multi-Disciplinary Team (MDT) meeting for an assessment to ascertain whether or not they have a ‘primary health need’ and could therefore be eligible for NHS Continuing Healthcare funding (CHCF).
The Multi-Disciplinary Team (MDT) meeting should take place within 28 days from the Checklist Assessment, however due to staff shortages and being able to co-ordinate a panel of assessors, these deadlines are rarely met.
Make sure you are given plenty of notice of the MDT so that you can attend and prepare. If the date is not convenient, then you must say so and try and get it moved to a date which is more convenient for you. However, don’t be surprised if your request is denied, but try and get the process to work for you.
It is essential that you or a relative who is attending the MDT assessment knows the individual well to get the best outcome. As the individual’s representative, you are encouraged to participate in the meeting, and by your presence you can see first-hand if the assessment is carried it out thoroughly, fairly and robustly. Attendance also gives you a great opportunity to put across your case, as you will be best placed to know your relative’s health needs. However, you may find the process emotional and overwhelming. You are entitled to have advocacy support if you wish, and you should consider this option. Read more about your entitlement to advocacy support.
What’s the purpose of the Multi-Disciplinary Team Meeting?
The MDT’s assessment follows a similar process to the Checklist Assessment and is the next stage along the journey to seeking NHS Continuing Healthcare funding.
The purpose of the MDT is to make a recommendation for eligibility for NHS Continuing Healthcare by looking at the individual’s health needs in detail across the 12 Care Domains (behaviour, cognition, physical/emotional needs, communication, mobility, nutrition, continence, skin integrity, breathing, drugs/medication/symptom control and also altered state of consciousness).
The NHS Healthcare Decision Support Tool (October 2018), states that, “The DST is “a National Tool which has been developed to support practitioners in the application of the National Framework as a way of bringing together information from the assessment of needs and applying evidence in a single practical format to facilitate consistent evidence-based recommendations and decision making regarding eligibility for NHS Continuing Healthcare”.
The MDT assessors will review the individual’s health needs by reference to the ‘descriptors’ in each of the 12 Care Domains set out within the Decision Support Tool. The needs are assessed and scored – from ‘no needs’ to ‘priority needs’. The DST scoring levels are merely to help inform consideration of the “primary health need test”.
It is often thought that the DST is the assessment of needs itself; but according to the National Framework, it is not. The DST is intended merely as a tool to help build a picture of the individual’s overall health needs in one document. So some high scores may be helpful to your case, they are not in themselves necessarily ‘the be-all-and-end-all’ – giving you an automatic entitlement to funding. The scores within each Care Domain have to be considered in conjunction with the four key indicators/characteristics (nature, intensity, complexity and unpredictability) which should be applied to the totality of needs. So, a score of a ‘severe’ and a several ‘highs’ may not get you over the hurdle for free NHS funding if in fact the 4 key indicators just aren’t there.
Where does the MDT meeting take place?
The MDT meeting should take place in a setting as near to the individual’s location as possible so that they can be actively involved in the process. This will usually be in the Care Home or Nursing Home or even in the individual’s own home, depending on the individual’s circumstances.
Who’s on the MDT panel?
The NHS National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2012) provides that whilst the minimum requirement of an MDT is for “two professionals from different healthcare professions, it should usually include both health and social care professionals who are knowledgeable about the individual’s health and social needs and, where possible, have recently been involved in the assessment, treatment or care of the individual”. Ideally there should be more than just two people because the MDT needs to draw on all the evidence about your relative’s health and care needs from all those involved in their care.
MDT members could potentially therefore include: Nurse Assessors, Social Care Practitioners, Physiotherapists, Occupational Therapist, Dieticians/Nutritionist, GPs/Consultants/Other Medical Practitioners, Community Psychiatric Nurses, Ward Nurses, Care Home/Support Provider Staff, Community Nurses, Specialist Nurses, Community Matrons, Discharge Nurses. The list is not exhaustive, but illustrative of people who may be invited to sit on the MDT panel.
There is a lot of potential information and evidence that the assessors can draw on when reviewing the individual’s health needs, for example: physiotherapy assessments, behavioural assessments,, care home records, current care plans, GP records, SALT assessments, Waterlow scores etc, but to name a few. More examples can be found on Page 73 in Practice Guidance Note 29 of the Framework.
Our TIP: Ask what information and evidence the assessors have already seen and obtained, and what other records do they propose gather when building up their picture of your relative’s health needs?
The NHS Healthcare Decision Support Tool (October 2018), states – and this is the important bit – that, “All staff who use the DST should be familiar with the principles of the National Framework and have received appropriate training”.
Important to note: It is therefore vitally important that the assessors should be people with direct knowledge of your relative and their needs, and have had proper training. Unfortunately, we often hear that some of those involved in assessments do not know very much about your relative, if indeed they have ever met them at all!
Some Assessors may be new the assessment process, or had insufficient training or experience, and/or may not be totally familiar with the NHS National Framework (or the Coughlan case) or how to accurately complete the DST. This may come as a surprise, but unfortunately it is not a totally unknown scenario. And, that is why your attendance at the MDT is vital. You are best placed to supplement information that may be of great assistance in helping the MDT panel understand your relative’s health needs and fill in any gaps in their information.
Pamela Coughlan Case
The MDT should be conducted in accordance with the principals enunciated in the Coughlan Judgment. For more information read paragraph 40 and Appendix B on p124 -125 of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2012). Essentially, the ‘Coughlan Test’ means that anyone with needs the same as or greater than Mrs Coughlan ie beyond the scope of Local Authority services, should in theory be eligible for NHS Continuing Healthcare funding (CHC). CHC is then the responsibility of the NHS to fund, which is free at the point of need; whereas local authority funding is means tested.
However, irrespective of Coughlan, it is important to note that each case though has to be assessed on its own merits. It is a common misconception just to compare needs to Mrs Coughlan’s case. You still have to consider the totality of needs.
If the assessors are familiar with the Framework and have been properly trained they will know about Coughlan. So, if you are met with a blank response when asking if the assessors are familiar with the Coughlan case, you will quickly realise whether they are really in tune with the National Framework.
Our TIP: We therefore suggest that you ask each of the MDT panel members:
- To introduce themselves;
- Explain their background and what qualifications they have in carrying out this assessment;
- How many previous MDTs they have undertaken?
- Are they familiar with the principles of the Coughlan case?
- How well and in what capacity they know your relative?
- What aspect of their care they have been involved in providing?
Make a note of the responses as it could give you grounds for appeal if the basic NHS Framework criteria above are not met.
Why not share your experiences of MDT meetings?
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I am currently appealing a decision following a rejection of an MDT meeting on 2.12.2019 and have found glaring errors in the process. I obtained all the papers the CCG and the Local authority had on me under freedom of information, and I found they had not disclosed important information about me that they held. I have a local resolution meeting to be arranged- should have been 27,5,20 but cancelled because of virus.
I had a further DST completed on 2.12.2019 and the LA did not agree the findings and on a number of levels, They submitted a rationale saying if they were called upon to provide my care they would not be able to as it would be illegal. They supported my claim at the highest level to have a primary health care need. (quoting the (nature, intensity, complexity and unpredictability) of my needs. The only reason I found out about this was because I asked the Social worker why she had not signed the DST. She told me of the rationale submitted by the LA to CCG.
I received the completed DST and the letter rejecting my application – the LA rationale was not attached or even mentioned neither were letters from three consultants who all said I had the needs for primary healthcare.
I am in the process of completing the appeal documentation but have since found further documents not sent to me until I obtained them under data protection. These included a ‘panel report’ which downgraded a number of my needs shown on the DST. It appears this was not relayed back to the MDT and in fact one of the members (District Sister) was not asked to sign the DST and when I showed it her she disagreed with levels attributed to her on the DST.
I have on a number of occasions, asked for the notes made by the CHC Assessor at the meeting but on both occasions they deny making any notes. This is impossible as not only did I see them making notes but it would be impossible if they did not for them to have produced so much on the DST from memory a week or more later.
I feel that I am up against a corrupt system which investigates itself and does not comply with the law.
On the DST of 12.6.2019 the Social worker disagreed on a number of the domains but these were downgraded by the Lead at the CCG misquoting something that was never said ‘I had refused to take certain medication and had no referral to mental health needs through my GP’. I am under the phycologist at the spinal unit at the hospital for life where I had re-habilitation. The social worker had not signed the DST until after the Lead at CCG had made their decision.
There are numerous other things wrongly and possibly illegally carried out but it goes on each time I look at the papers I find wrongly quoted or carried out parts of the procedure.
We have been told that we can have a “family” meeting to discuss my father’s discharge from hospital (which they want to do as soon as possible it seems) and we have brought up CHC. We were then told that he would therefore have to be sent to an intermediate care home for 3 weeks while they make the assessment. Is this the case?
You know why they want to send your father to a care home? Because care home managers earn more profit, the more people they can swindle into staying in their care home. Don’t be fooled into thinking they they’re doing this in your father’s “best interests”. Insist then that he stay at the care home only for three weeks, because the number of residents I hear from, who were meant to leave care homes, only to be left there for years by their social workers is beggars belief. Why should it matter about care home managers making as much profit as they can? Are they superior to any other kind of manager in any other business sector? Who said that they were so special? They’re only as good as the town they’re from. Insist that your father would prefer care in his own home, when you next speak to his MDT, because then he wouldn’t have to sell his home to go into a care home. What I can never get my head around, is why anyone would agree to sell their own home, before they’ve even decided whether they want to live in a care home in the future.