We have been asked recently about the difference in the role of the Multi-Disciplinary Team co-ordinator and a Multi-Disciplinary assessor – and can they ever be the same person?
So, let us explain….
If your relative passes the initial Checklist, the matter should be referred to a coordinator at the Clinical Commissioning Group, who then has the responsibility of arranging a full assessment for eligibility of their health needs at a Multi-Disciplinary Team (MDT) meeting.
Essentially, the coordinator’s role is to find appropriate assessors to attend the MDT on behalf of the CCG, coordinate a suitable date for the MDT meeting to take place, gather assessments and as much other information as possible from professionals involved in the individual’s care prior to the Meeting, and of course invite the individual and their representative(s) to attend.
Make sure you are involved in this process and are given adequate notice of the MDT meeting so that you can attend. Read our blog What Happens At The Multi-Disciplinary Team Meeting for more useful information.
The MDT Panel
The MDT panel of assessors should consist of people treating or supporting the individual and who are therefore familiar with their daily health needs.
The NHS National Framework for NHS Continuing Healthcare specifically states that the assessors should be “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”.
The coordinator is responsible for bringing these people together to make the assessment meaningful.
The coordinator is usually a member of the CCG’s staff, but they can be from an external organisation such as the Local Authority, an NHS Trust or an independent sector organisation.
Note: The coordinator is supposed explain the process to the individual and advise as to ways in which they (and their family) can participate in the MDT, including the ability to have advocacy help – and even though you will be no doubt told you don’t need support, you might find a professional advocate invaluable at this important juncture of the process. We have considered the role of advocacy in a recent blog.
The Primary Role of the Coordinator
The coordinator should support the MDT assessors; help them understand their role in this process; and ensure that they complete the Decision Support Tool (DST) following the MDT meeting. However, you would have expected that the assessors attending the MDT would have had sufficient training and already be familiar with their role, the principles of the NHS National Framework (and the Coughlan case) – but don’t be surprised if that is not the case!
What About Conflicts Of Interest?
The coordinator is supposed to be acting as an impartial resource to the MDT, both to help the individual and the assessors on any issues as to policy or procedural questions that may arise. Sometimes the coordinator can also be a member of the MDT assessment panel too!
This could present an obvious conflict of interest.
The coordinator is, nevertheless, permitted to contribute to the decision making process and make recommendations to the CCG as to eligibility. To avoid any potential conflict of interest, the coordinator must declare this dual role and keep their specific functions separate.
Other Roles of the Coordinator
A coordinator should also try and ensure that the DST is completed as soon as possible after the MDT, and when available, check it to confirm that sufficient evidence and a clear rationale to support the recommendations exists before submitting it to the CCG panel for their consideration and ratification.
The coordinator is also responsible for communicating the CCGs outcome on eligibility for NHS Continuing Healthcare funding in a timely manner. There is no set timescale imposed and much really depends on how quickly the CCG panel can review the matter. This can be the next day or even some many weeks later – it all depends on the CCG and their available resources.
If you are not happy with any aspect of the process or the MDT meeting, you can take the matter up with the coordinator who should try and address and resolve those concerns.
Look at our helpful blog on Attending the Multi-Disciplinary Team meeting – some useful guidance
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I have had six years of hell trying to obtain continuing healthcare,this is not due to me not being eligible,its to due with me being eligible,with out going into a very long storyline will just say l am now refusing to pay my contribution to my care package ( for people who wish to know if my care needs are health needs,here are my health needs,31 long term illnesses and in palliative care for heart failure, which have been seen as social care needs)
I am hoping,others would follow my actions,because if they do it will throw a huge hammer,into their illegal criteria they have been using for years unfortunately you have to get militant,or nothing changes.
Valerie bradley
Please can any one help me, I have a father with Lewy Body Dementia and despite two failed discharges from Hospital and failing a check list , then challenged and fulfilled it it was never logged in the discharge process. It’s been hell but I have just managed to get a full CHC assessment and have succeeded.
The CCG have not kept us in the loop We feel excluded from decision making despite raising these concerns. We have never had a social worker in two years and even the duty social worker never even turned up at the CHC full assessment despite repeatedly asking for one.
My despair now is dad ended up in a care home that was found to be clinically unsafe following a failed discharge confirmed by the CCG. The CCG confirmed dad had been successful in getting CHC funding. Brockerage phoned me the same day and told me what nursing home had a place . when we went to look it was not in dads best interest to send him there. Dad is 78 years old and is frail and has complex health needs where he becomes unresponsive, high risk of falls and has had 1-1 support in hospital and in the D2A bed for months. The CHC say that there is no where that will provide 1-1 care and this first choice of home had young adults with challenging behaviour, some having schizophrenia, and drug problems. I understand people have mental health needs but feel dads needs require specialist nursing care. Dad cannot see properly, hallucinates and doesn’t understand others personal space putting him at high risk of harm. We rejected this offer and were told to look at another home again for young people with challenging the same as the last choice. We found a nursing home our selves he was assessed and they said he could go there, but after an incident at the D2A placement Dad became ill and an incident happened where we have had to report to CQC. Dad went into hospital into A and E and remains in hospital. The nursing home that had accepted dad re assessed and then declined to have him and the nursing home D2A bed was closed leaving Dad with no where to go. We were given another home to look at which could fulfill his complex nursing needs and he had been assessed and accepted. Dad is still in hospital and again waiting for things to happen . The CCG said they are negotiating funding details as 1-1 is the problem and don’t want to find this I feel. The nursing home manager has told us that the CCG is looking at temporarily funding his bed. We have had no further support and feel excluded from all decisions being made.
I have been told that we may have to go back through to the beginning to a check list again, go through another discharge into a D2A bed for another six weeks and go through a full assessment again.
Mum and I are now becoming very ill with the system we have no one supporting us.
The whole pathway had been unethical and Dad has frequently been put at risk on numerous occasions.
Dads quality of life has been compromised by the lack of understanding, and an awful failing in hospital discharge process being placed in an unsafe care home and now stuck in hospital with no help from anywhere.
Can any one please help us. I have contacted my MP three times and have had no response. Dad has Lewy Body dementia and Alzheimer’s and is need of nursing care under the CHC process. It’s hard enough dealing with seeing dad so poorly but the whole process of CHC and the Hospital discharge has been so cruel. We are on our knees. Someone please help us.
Tracey – this is awful. Do call us when convenient – we will be delighted to see if we are able to offer you some support. 0161 979 0430 Kind regards
I was certain that no-one working in the CCGs CHC office had ever read the NF. Everything they said whenever I spoke to them indicated complete ignorance. When trying to arrange an assessment I asked about “the co-ordinator” – their response – What co-ordinator? What are you talking about? Why do you want a co-ordinator? We don’t understand what you are asking for. What do you mean support you through the process? They then in exasperation, behaving as though I was being unreasonable, said why did I need a co-ordinator, they had sent me a leaflet what else did I need to know? . My belief that no-one at the CCG from the board of directors downwards had read the NF was clearly right. They had never heard of Coughlan either. For me this CCG’s own name for their CHC department said it all – it was called the Business Support Unit. It was clearly all about money.
Don’t give in to this nonsense.
Almost every year I have appealed and won.
I now have health issues myself but I will not give in and I’m ready for 2019.
Now checking home records, specialist visits, Doctors visits and reports .
Why they can pretend there is an improvement I don’t know . After 6 years of obvious decline in my wife’s illness to the stage that it is now only a short matter of time before the end, why are they making my deteriorating health worse with this nonsense .
Why they put families through this is beyond belief. Keep fighting. Regards
The following is a cut and paste copy from page 119 Para 25.1 of the new revised national framework, due to be released on the 1st October 2018 (next month)
25.1 The role of the ‘co-ordinator’ in the context of NHS Continuing Healthcare is set out in Practice Guidance note 20. All aspects of the co-ordinator’s role are important and part of the role includes ‘acting as an impartial resource to the MDT and the individual on any policy or procedure questions that arise’. Some have asked whether this means that the ‘co-ordinator’ cannot actually be a member of the MDT. If this were the case it would always be necessary to have a minimum of two professionals from different healthcare professions, or one from healthcare and one from social care, in addition to the co-ordinator. It is recognised that in many situations this would raise significant practical difficulties in convening a properly constituted MDT
Note: To constitute: give legal form to assembly.
The national framework and its associated tools are underpinned by legally binding Directions and Standing Rules.
Perhaps someone could explain why the NHS are unable to provide an individual with a properly constituted MDT?
Below is a copy of a summary from the House of Commons committee of Public Accounts, NHS Continuing Healthcare – Thirteenth Report of Session 2017 – 19:
Summary:
NHS continuing healthcare (CHC) funding is intended to help some of the most vulnerable people in society, who have significant healthcare needs. But too often people’s care is compromised because no one makes them aware of the funding available, or helps them to navigate the hugely complicated process for accessing funding. Those people that are assessed spend too long waiting to find out if they are eligible for funding, and to receive the essential care that they need. About one-third of assessments in 2015−16 took longer than 28 days. In some cases people have died whilst waiting for a decision. There is unacceptable variation between areas in the number of people assessed as eligible to receive CHC funding, ranging from 28 to 356 people per 50,000 population in 2015−16, caused partly by clinical commissioning groups (CCGs) interpreting the assessment criteria inconsistently. The Department of Health and NHS England recognise that the system is not working as well as it should but are not doing enough to ensure CCGs are meeting their responsibilities, or to address the variation between areas in accessing essential funding. NHS England wants CCGs to make £855 million of efficiency savings in CHC and NHS-funded nursing care spending by 2020−21, but it is not clear how they can do this without either increasing the threshold of those assessed as eligible, or by limiting the care packages available, both of which will ultimately put patient safety at risk.
From Maureen: My mum was taken into care against both our wishes she had dementia but it was quite mild however she lived in a McCarthy and Stone retirement flat and the house manager said she would keep going down. There was a management group and they gave me a list of complaints mostly really exaggerated and one a complete lie! I contacted the care coordinator who had seen Mum a few times and always praised us both how well mum was cared for then she went to see the house manager then came back totally different and said mum needed to go into respite for two weeks with a view to going into care for good but said she we would have time when mum came home after respite to find a forever home. Then I had a phone call from her today mum couldn’t come home as she was a danger to herself! I was upset and mum was too . When mum was being assessed she didn’t get CHC I had previously been told she should never have been put in a home. So we had to sell mum’s flat at a loss to pay for her care. Her flat was sold for£120,000 and so far half of it has already go in care fees . I feel sorry for mum she has gone down hill since being in a Home finds it difficult to walk she is incontinent too. She has had numerous falls and is unhappy. When mum was in her flats She only had Carers in the morning and the care Co ordinator wouldn’t let her try having them in the evening too as mum was self funding once she sold her chat she said she would have to have wherever was cheaper meaning for the social services. Mum was healthy and happy till She went into care. She is 95 now. She could have seen out her days living in her flat going to the day centre that she loved. I used to go round to mum’s three or four times a week did her washing ironing shopping housework and we went it for afternoon tea. I feel upset that the care Co ordinators have such power they can put people in care when they don’t need to be. If mum hadn’t owned her flat she would still be living there. I complained at the time and got in touch with Ombudsman but she sided with the social workers without ever having met mum!
Feel defeated upset and angry.
From Geoff: My brother and I recently attended a CHC MDT assessment for my 95 year old mother who has serious Lewy Body Dementia and is deteriorating rapidly. The meeting was a complete and utter farce and in my view the outcome was pre scripted before the meeting even started.
We had gone to great lengths to prepare for this meeting since it followed a similar MDT assessment about 18 months ago, so we were well versed in what to expect.
Previous to the meeting we had attended the Care Home and viewed in great detail the daily care notes and other documents which were very detailed and gave a good indication as to her condition.
My brother and I both did our own assessments based on the Framework and scoring in the various Domains.
During the course of the assessment, we objected and put forward our views supported by the care notes to many of the issues raised and submitted copies of our own assessments to the Co Ordinator. The Social Worker and Care Home Manager who attended were almost silent and made no contribution throughout.
This all proved to be a waste of time and could not believe the outcome…..
18 months ago in the previous assessment my mother scored “severe” in the Cognition Domain, and a number of ‘Highs’. She is now very much worse than 18 months ago, however, for Cognition this assessor has now scored her down as “High”. I commented that a person with Lewy Body Dementia cannot make this sort of miraculous recovery and the care notes do not reflect any improvement at all. This was met with silence.
The full report makes little mention of the relatives inputs and does not include a copy of our notes / assessments which were passed onto the Co Ordinator. Needless to say we were advised that she did not meet the criteria for CHC and despite being totally disorientated, having sever periods of anxiety and violent outbursts against staff and other residents, the CHC report indicates that “they could find no evidence of complexity with any interaction of symptoms that pose difficult to manage” …….. Again .. what a complete and utter farce. It was a waste of our time being there.
We are considering on what grounds we may appeal.
Geoff, I’m in EXACTLY the same situation as you. Spent four hours on Wednesday in an MDT meeting which was a farcical, total waste of time ! Mum was Fast Track – which has been taken away after 12 weeks because she hasn’t died. After the DST was completed ( yet again) they didn’t even find her eligible for CHC. I already have one Appeal in … now I have a second to submit. Disgusted and angry with it all!
Would be happy to share advice/ compare notes with you.