Your essential guide to getting assessed for NHS continuing healthcare funding. Part 2

Posted on: September 5th, 2016 by Meelee Parsons

Part 2: The Full Assessment of Need – what is it and who completes it?

If a Screening Checklist has been completed (see Part one) and indicates you’re eligible for a full assessment, your clinical commissioning group (CCG) should get the ball rolling to get this completed.

In part two of our guide to the assessment process for NHS continuing healthcare, we will outline what to expect from a full assessment, who should be involved, and what it comprises.

If you have questions or concerns about your Full Assessment of Need – or any other part of the continuing healthcare assessment process – you can talk to a Beacon advisor for free.

Who carries out the full assessment?

Full assessments are completed by a group of people who are involved in your care. The team is brought together and led by a coordinating assessor, who is appointed by your CCG.

The assessment group is known as ‘the multidisciplinary team’, and you may see this shortened to MDT. Ideally this team would comprise all the health and social care professionals who are knowledgeable about your needs. The absolute minimum that a team can comprise is a healthcare professional and a social care professional, or two professionals from different healthcare professions.

Your involvement in the full assessment

The person being assessed, or their representative, should be involved at every stage. It is part of the coordinating assessor’s role to invite you to contribute to the assessment, often at the meeting of the multidisciplinary team.

The coordinating assessor should help you to understand the criteria and processes during the meeting, and this will help you to contribute the most relevant evidence and information. We have lots of information to help you make a valuable contribution at an assessment meeting in our free Navigational Toolkit.

What does the full assessment involve?

The assessment will be completed at a meeting of the multidisciplinary team, where the severity, complexity and predictability of your needs across 12 areas will be discussed. These areas, known as ‘care domains’, are:

  • Behaviour
  • Cognition
  • Psychological and emotional needs
  • Communication
  • Mobility
  • Nutrition – food and drink
  • Continence
  • Skin and tissue viability
  • Breathing
  • Drug therapies and medication: symptom control
  • Altered states of consciousness
  • Other significant care needs

The multidisciplinary team uses the evidence that has been provided to assign a level of need against each care domain. The level of need ranges from ‘no need’ to ‘moderate, ‘high’, ‘severe’ or ‘priority’.

Assessments of need are inputted into a detailed form called the decision support tool – often referred to as the DST. Once the DST has been completed, the coordinating assessor should give you an opportunity to review it and add your views in the designated part of the form.

Once completed, the MDT will make a recommendation to the CCG as to whether or not they think you meet the eligibility criteria. The MDT do not have to involve you in this discussion.

What information do they use to make their decision?

All written or verbal information about your needs within the assessment period should be taken into account. This information might include care plans, hospital records, social care records, GP records, medication charts and daily care records.

We cannot stress enough the importance of doing what you can to ensure the multidisciplinary team have full and accurate records on which to base their decision. Here are some tips on getting paperwork ready before an assessment.

CCGs usually make the final decision about your eligibility for continuing healthcare funding. However, they should accept the recommendation of the assessment team in all but exceptional circumstances.

What if I disagree with the decision?

After the assessment you should receive a decision letter from your CCG promptly, with a rationale for how the decision was made.

You have six months from the date of that letter to request a review of the decision, and the appeal process has various stages if you’re not satisfied with the outcome.

Grounds for appeal could be the eligibility decision, the procedures used to make it, or how the criteria have been applied.

The first step in appealing a decision is to write to the CCG outlining your reasons for requesting a review. It’s worth preparing this letter carefully, and we have detailed guidance to help you in our free Navigational Toolkit. Alternatively call our free Information & Advice line for personalised guidance.

 

About Beacon

Beacon CHC is a leading UK-wide social enterprise with profits donated to charity to fund vital older peoples’ services.

Our specialist caseworkers provide a comprehensive and ethical advocacy and support service for individuals trying to navigate the maze of NHS continuing healthcare funding.

We also run an independent support service – funded by the NHS – for people in England who need free information and advice in relation to NHS continuing healthcare.

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