By Rosalind Hughes, founder, Just Caring Legal
The NHS Continuing Healthcare Decision Support Tool, contrary to popular belief, is not in itself an assessment of care needs. The regulations governing NHS Continuing Healthcare are clear. When deciding eligibility for NHS Continuing Healthcare, a multi-disciplinary team (MDT) must first undertake a comprehensive assessment of needs. The MDT must then use that assessment to complete the Decision Support Tool for NHS Continuing Healthcare. This is designed to help them accurately reflect the nature, intensity, complexity and unpredictability of care needs in the round. It is this which must inform the decision as to whether that person has a primary health need and is therefore eligible.
However sadly, in our experience, this is not how it usually goes.
How is the NHS Continuing Healthcare Decision Support Tool misused? Let us count the ways.
1. The Decision Support Tool becomes an assessment in itself.
The MDT meets – remotely, these days – to complete the DST. This “team” is often made up of just two people: a nurse assessor for the Clinical Commissioning Group and a social worker. It is increasingly rare that these professionals have ever met the person they are assessing. Even rarer that they have observed them in their care setting. They may well be examining their care needs in detail for the first time as they fill in the document.
2. The DST is based on very limited information.
According to the National Framework, the Multi-Disciplinary Team should gather evidence of needs from a comprehensive range of assessments relating to the individual. But this often doesn’t happen. Many DSTs are rushed, and rely too heavily on whatever information is available in the day-to-day care records.
3. The Decision Support Tool is completed behind closed doors.
We are finding that families are not always getting the opportunity to be fully involved in the assessment process. Their only chance to have an input may be in a preliminary telephone or Zoom conversation. The MDT then scores the care need domains in the DST in private. Of course, this makes it easier for them to disregard or minimise the family’s views and evidence. Many families don’t find out the outcome of the DST until they are notified of the eligibility decision. This is all contrary to the National Framework, which says the family should have the opportunity to be fully involved in the assessment process.
4. It makes it possible for the assessors to “underscore” care needs.
They may justify this by saying: “There is evidence that x’s needs fit the descriptor for the higher scoring in the DST some of the time. But there is insufficient evidence from the care records that it happens often enough to justify this higher scoring”. It is very rare that the MDT asks, in line with the National Framework, for further evidence to get a more accurate picture of needs. Instead, the lack of care records simply becomes evidence of lack of care needs.
5. The Decision Support Tool misinterprets well-managed needs as no or reduced needs.
For example, the DST often fails to examine or record the content of risk assessments or care plans. Day-to-day care records may be incomplete – care staff are often too busy to fill them in comprehensively. It can create the impression that care needs are far lower than they actually are. This is very common in reassessments for eligibility. The DST can make it look as though the care need has permanently reduced purely because it is being well-managed. It can fail to capture the amount of care going into keeping someone safe and well. That is why it is always worth asking the question: what would happen if the current level of care were withdrawn?
Is this your experience too?
Has the DST failed to capture the totality of your family member’s care needs? Or maybe you are waiting for an eligibility assessment and don’t know what to expect. Why not give us a call? We can talk you through the process and the possible pitfalls. We can make sure the decision-makers follow procedures so you can be fully involved in the process. And we can pre-empt problems with the DST by providing a preliminary assessment of needs to present to the MDT. We can even represent you in the meeting, if this is what you require. We pride ourselves on our specialist, client-focused service, giving as much or as little support as you want. And that can start today, with a free initial assessment of your case.