By Rosalind Hughes, founder, Just Caring Legal
The short answer is yes. You do have the right to be present at an NHS Continuing Healthcare eligibility assessment if it is for you or a close relative or friend. (And no, you don’t need power of attorney.) However, people all over the country have been getting in touch to tell us that they have been shut out of their relative’s NHS Continuing Healthcare eligibility assessment. They say NHS CHC assessors have contacted them to ask for their views on their care needs. But then the Multi-Disciplinary Team (MDT) has gathered to assess care needs in a separate meeting. This is the crucial meeting to decide if your needs constitute a primary health need and therefore if you are eligible. This is happening so widely that we have sent an open letter to all CCGs in England calling them out on this unacceptable practice.
Why are CCGs denying people the right to be present at an NHS Continuing Healthcare eligibility assessment?
CCGs are under enormous pressure right now. They have a huge backlog of assessments created by the pandemic. Plus they have a six-week timeframe in which to assess the care needs of all people newly discharged from hospital. Any longer, and they have to take on the care costs themselves.
But that is no excuse for riding roughshod over people’s rights. Excluding vulnerable people and their representatives from crucial NHS Continuing Healthcare eligibility assessments certainly makes it easier and quicker for them to get to “No”. But it is against both the spirit and the letter of the National Framework. This is the guidance all CCGs must – by law – follow when making decisions about NHS Continuing Healthcare. The National Framework emphasises that the entire eligibility process must be person-centred. This means families have the right to be fully and directly involved in it. The MDT must listen to their views and give them due weight. After all, they usually know the person’s needs better than anyone else in the (Zoom) room. And they have the right to say if they disagree with the assessors’ views, and to have those disagreements recorded.
The National Framework requires that all reasonable efforts should be made to involve the individual and/or their representative in the assessment process. Covid-19 precautions should not generally preclude full and direct involvement in the completion of the eligibility process. We have attended many digital MDT meetings via Teams or Zoom since September 2020 and (surprise, surprise) they work perfectly well.
What does the National Framework say about people’s right to be involved in the MDT?
The MDT meets to complete the Decision Support Tool (DST). This is a document that enables the assessors to “score” care needs in 12 different domains. They use these “scores” – ranging from No Needs to Severe/Priority – to guide their decision-making. High or severe needs across multiple domains may suggest a primary health need. The MDT must then use its professional judgement to decide how intense, complex and unpredictable the care needs are. It is this that determines eligibility.
The MDT co-ordinator must arrange the assessment meeting so you can give your views on the completed domain levels before you leave. The MDT must record whether:
- the individual being assessed was involved in its completion
- they were offered the opportunity to have a representative
- the representative attended the DST completion
- the MDT assessment accurately reflects their view of their care needs
- they contributed to the assessment
- they agree with the domain levels selected (and if not, why not).
It is the role of the NHS Continuing Healthcare coordinator to support you to play a full role in the eligibility assessment process. That includes organising the overall process in a manner that maximises your ability to participate. It is also includes ensuring the DST is completed in accordance with the requirements in the National Framework.
Have you been denied the right to be present at an NHS Continuing Healthcare eligibility assessment?
If so, have a read of our open letter here. It may give you some useful tools to take the fight to the CCG. Let us say again – your rights must not be an afterthought. It is absolutely central to the whole NHS CHC process that your views get full weight. So if you feel you need more advice and support, why not call or email us today? There is no obligation – the first chat is free, and we can give you a useful assessment and advice on how to take things forward. But if you prefer, we can also be your voice and your advocate throughout the process. As many of our clients have learned, that can make all the difference in a system that seems designed to get to “No” without passing go.