As a result of a Positive Checklist, the claim proceeds to the next assessment which is undertaken using a ‘Decision Support Tool’ (DST) – this is used across the NHS for the purposes of assessing claims for Care Fees Funding. It’s use has been agreed by NHS England as being the appropriate way of advancing claims. The DST is completed by a Multi-Disciplinary Team (MDT) – comprising of a Nurse Assessor and a second health professional or Social Worker in addition to any other relevant professionals involved in delivering the care at the time of the assessment.
The Decision Support Tool – A National Framework
It is also within the National Framework that the family of any Applicant is also involved in the assessment (if the Applicant has capacity and agrees to the family input). The Decision Support Tool contains 11 specific ‘domains’ and one further domain which is for the inclusion of any needs which are not covered by the previous 11. The 11 ‘specific’ domains are:
- Behaviour, Cognition, Psychological and Emotional, Communication, Nutrition, Mobility, Continence, Drugs and Therapy, Breathing, Altered States of Consciousness, Skin Integrity.
- The 12th domain is there to comply with the National Frameworks concern that:
“In certain cases, an individual may have particular needs that are not easily categorised by the care domains described here. In such circumstances, it is the responsibility of the assessors to determine the extent and type of the need and take that need into account (and record in the 12th care domain) when deciding whether a person has a primary health need.”
These ‘domains’ are scored on a scale of ‘no need’ up to ‘severe’ and then ‘priority need’ with categories between these.
If the DST indicates the presence of a health need then funding must be awarded for the patient’s full care. If the MDT fails to find that there is a health need then this decision is sent together with the appeals procedure to the Applicant for funding.
A clear recommendation of eligibility would be expected if the individual undergoing assessment has:
- priority level of need in any of the four
- two or more instances of severe needs across all domains
If the following apply, this may, depending on the combination of needs, also indicate a primary health need:
- one domain recorded as severe together with needs in a number of other domains, or
- a number of domains with high and/or moderate needs.
So that’s the DST – and whilst is appears to be a straight forward assessment we can assure you that it can be fraught with problems. It is incredibly common that the team doing the assessment is not properly constituted or fail to consider essential evidence such as that from care notes or anecdotal evidence from friends and families of the Applicant.
At Seatons we are fairly unique in that we directly employ medical staff to attend the assessment if needed and ‘shadow’ assess the Applicant. Our Lead Nurse Assessor, a Registered Mental Nurse, has years of experience of assessing Applicants for CHC funding – she has worked within the system and knows the pressure that is sometimes applied to save the NHS money by finding Applicants’ needs lacking.
Ultimately, if there is no primary health need found, then it is usual that the Applicant will be forced to pay for some, most or all of their care – and with costs in some instances being over £1,000.00 per week for care, it makes sense to ensure that your Application is done properly with all the evidence fully considered – this is what our medics and lawyers do.