The checklist & Decision Support Tool (DST)
So how does NHS Continuing Healthcare funding work? A meeting is called and the multi-disciplinary team should meet the individual and then complete a checklist (if they choose to do one) and if that stage is passed, then complete a Decision Support Tool (DST).
The checklist is a bit like a DST light!! It has the same “domains” (areas of healthcare need) and the wording is the same as the scores for “no needs & low”, which scores C on the checklist, then the “moderate” descriptor scores B and the “high” descriptor scores A. They do not include the descriptors for “severe” or “priority”. So the checklist is completed and scored, if the outcome is 2xA or 5xB or 4xB+1xA or 1xA*, but not every A has an *!
Although the checklist is meant to be a relatively quick process and if you don’t pass the checklist, you do not go on to complete the DST, it should still be done properly as it is possible to fail a checklist due to lack of care on the process. In order to know if someone will pass, it has to be scored correctly and for it to be scored correctly; the person completing it must know all about the individuals needs. The person completing the checklist can be a medical professional or a social worker and it only needs to be completed by one person. From the date that the checklist is completed the clock starts to run and the outcome of the assessment should be completed within 28 days, it often runs overtime, but at least having a clock ticking moves the process along!
So having completed the checklist, the next stage is the meeting of the Multi-Disciplinary Team (MDT) and the completion of the DST. The MDT should by law consist of at least 2 people, who are healthcare professionals, one of them can be a social worker (but does not have to be). The purpose of the social worker is to decide if the person’s needs are at a level that Social Services could lawfully provide for, if it isn’t then their needs MUST be healthcare, as they cannot be anything else! The members of the MDT should also have training, as they should understand what they are meant to be doing. Some people have other jobs and sometimes they are full time assessors, those that do nothing else but complete these forms and undertake assessments are therefore usually far more experienced in the completion of the forms and know what the Panel are looking for.
The individual should take part in this process and if they have a cognitive impairment, as often happens, then an advocate should attend on their behalf, which is usually a family member and when I attend, I attend in this capacity as advocate.
The MDT often arrives early to read through the care home notes, as they are looking for evidence, as it is an evidence based process, however it should not be forgotten that the word of the carer is also evidence as a conversation with them can give far fuller information than the care notes can commonly. So the meeting should consist of the 2+ MDT members, a carer and the individual and/or their advocate. They then get into the detail of discussing the needs of the individual in real detail.
The MDT then go through the 11 named “domains” and the final domain known as “domain 12”, which is meant to cover anything that has not already been covered in the first 11. Mostly the first 11 do cover what is going on and commonly domain 12 is not used. There should be input from all parties and if the MDT and family / advocate don’t agree on something, then the disagreement should be noted. The MDT alone make the recommendation and the case goes to Panel for ratification. The Panel should only ever not ratify the MDT’s decision in very rare occasions, but in practise, it is very common and this can be a reason for appeal. I however would always want to ensure that there is a clinical reason for appeal, as I see no point in going through the process of appeal if the outcome is not likely to be successful, and it wouldn’t be if there was no clinical reason for appeal.
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