Are you getting the most out of the Multidisciplinary Team assessment?

In order to establish whether your relative meets the criteria  for NHS Continuing Care Funding (‘CHC’), they’ll need to undergo a multi-disciplinary team assessment, often referred to as the “MDT”.

If your primary need is for healthcare, the NHS is legally required to fund the full cost of care, including accommodation.

The first stage of the assessment process is to have an initial Checklist completed. You can read all about this in our previous article, “The NHS Continuing Healthcare Funding Checklist Explained.”

If your relative passes the Checklist stage, they will then go on to a full assessment, which is carried out by a multidisciplinary team, or MDT. This is why the full assessment for CHC funding is often referred to as “the MDT”.

The National Framework explains that the MDT should consist of at least 2 professionals from different backgrounds – ideally, a nurse and a social worker, although two nurses of different specialisms is acceptable.

Important: The MDT must be trained in the application of the National Framework, be knowledgeable about your relative’s care needs and, where possible, have recently been involved in their treatment or care.

We know from experience that it is quite common for the MDT to have little to no knowledge of the person they are assessing. Indeed, they may never have met them before. This can lead to poor assessments, with unjust outcomes for families who feel blindsided by the process. As NHS resources are stretched to the limit, even the most obvious cases of CHC eligibility can be an uphill struggle. Sadly, nothing is guaranteed and you should not be complacent.

The MDT will speak to the people caring for your relative to build an overall picture of their care needs. They should also consider essential care and medical records.

Unfortunately, care home records are often not as detailed or accurate as they should be, because staff are either not properly trained in what should be documented or are too busy doing other things. Sadly, most care homes have too few staff looking after too many residents, and there’s simply not enough time in the day to write up each and every occurrence as it happens. Staff may write up care records at the end of their shift which, after a long day, can lead to errors and omissions. Many care providers will also try to put a positive spin on things, for fear of upsetting the family.

Care records are a vital part of the CHC assessment process and poor record-keeping can often result in a poor outcome. Where Continuing Healthcare funding is concerned, the devil is in the detail and the general rule is that if it isn’t written down, it didn’t happen. So, in preparation for the MDT, you should ask to see your relative’s records to check they are as accurate and detailed as possible. Care Plans are particularly important in describing the interventions required each day; however, these are drafted upon admission to care and may not be updated as things change. In preparation for the MDT, it is a good idea to make sure the Care Plans accurately reflect the care being provided to your relative each day. If you’re concerned the records are not accurate, have a chat with the care home manager or person in charge and ask that the records be updated or improved. If, by the point of the MDT, you remain dissatisfied, make sure you raise this at the meeting and ask that your concerns are documented.

As with the initial Checklist, you should be given plenty of notice of the MDT. It is essential that you attend to ensure the assessment is conducted impartially and robustly. You can play a vital role by providing additional information about your relative’s daily care needs and correcting any errors or misunderstandings. Don’t assume the MDT have all the facts and are above reproach. You will know more about your relative’s needs than them. So speak up!

It is increasingly common these days for MDTs to be conducted virtually, using Microsoft Teams. If you don’t feel comfortable with this, ask the ICB to arrange an in-person assessment.

The Multi-Disciplinary Team will assess your relative’s needs using the a document called the Decision Support Tool (DST).

The DST contains 12 subsections, known as Care Domains, similar to the Checklist, but with the added 12^th Domain of’ ‘Other Significant Needs’:

1. Breathing 2. Nutrition 3. Continence 4. Skin Integrity 5. Mobility 6. Communication 7. Psychological & Emotional Needs 8. Cognition 9. Behaviour 10. Drug Therapies and Medication 11. Altered States of Consciousness 12. Other Significant Needs.

The MDT will go through the DST chronologically, discussing each Care Domain in turn. Once all relevant evidence has been gathered in that domain, the MDT will assign a “level of need”, choosing the description that most closely matches your relative’s needs from the table of options. If there is disagreement between members of the MDT about a level of need, the higher level should be applied.

Here’s an example of the ‘Behaviour ‘domain…

9. Behaviour

Remember: Not every domain has a severe or priority weighting. You should familiarise yourself with the descriptors in each Care Domain before the MDT, and think about which level of need you feel is most accurate.

Many people mistake the levels of need as being the determining factor in deciding eligibility for CHC Funding. However, while a recommendation of eligibility for CHC is “expected” if there is evidence of one “priority” or two “severe” levels of need, the levels of need are only a guide and it is not necessary to meet this threshold in order to qualify.

Once all 12 Care Domains have been completed and assessed, the MDT will analyse the four “Key Characteristics”, of nature, intensity, complexity and unpredictability. Also known as the “Primary Health Need Test”, it is the Key Characteristics – not the levels of need – that determine eligibility for CHC Funding.

When thinking about the 4 Key Characteristics, consider the following:

• How often do care interventions arise over a 24-hour period and how long does it take staff to meet the need on each occasion; how many members of staff are required for each intervention (Intensity)?
• Do the staff need any specialist training, knowledge or skill in order to meet the needs and do needs interact (Complexity)?
• Are the needs unstable and/or rapidly changing (Unpredictability)?

This will build a picture as to whether your relative’s care needs are outside the remit of Social Services.

Attending an MDT assessment can be a stressful and daunting experience, and often fills families with much anxiety. Most family representatives don’t really understand the National Framework, how the assessment process works, what is expected of them at the MDT, or what they should or shouldn’t say. The assessors will be far more experienced and should know the National Framework inside out. They should come with an open mind, conduct a fair and thorough assessment and make an impartial recommendation as to your relative’s eligibility for CHC Funding.

However, we often hear that MDT assessments do not go as expected. Sadly, some assessors appear to come with a predetermined outcome (i.e. to refuse funding) and no matter how much the family try to argue their case, they feel overwhelmed by the assessors’ aggressive or indifferent stance.

The MDT is your first real opportunity to secure long-term fully-funded free care for your relative. It is, therefore, critical that you give this meeting your best shot. Otherwise, your relative may end up paying huge sums for their own care and accommodation.

Good preparation for the MDT is the key.

Here are our top 10 tips:

1. Have a look at the care records in preparation, especially the Care Plans; do they accurately describe your relative’s needs?
2. Speak to the care home staff in advance and make sure they send the person who knows your relative best to the MDT.
3. Speak to this person and let them know how important it is to give detailed, accurate information to the MDT. Inaccurate or ‘loose’ phrasing may paint a misleading or entirely different picture of your relative’s needs.
4. Participate in the meeting and don’t be a bystander! You know your relative’s needs better than the assessors – so stand up, speak up, and don’t be afraid to correct any misgivings they have.
5. Highlight any of the care records you think are particularly relevant and provide a copy of the pages, if possible.
6. Look at Practice Guidance Note 22 of the National Framework which lists the type of information and evidence the MDT should consider as part of its assessment.
7. Remain focused. While you’ll want to give the MDT chapter and verse about your relative’s history, it is vital that you stick to discussing their current presentation and care requirements.
8. It’s a good idea to take someone along with you for notetaking, if possible, as a good record may become useful evidence if you need to lodge an appeal.
9. Do not engage in any discussion about how your relative’s care will be funded at this stage! It is completely irrelevant and has no place in the assessment.
10. Consider enlisting the services of a professional advocate, such as Farley Dwek, to support you at the MDT.

The NHS is keen to tell families that they do not need any professional help in navigating the CHC process and that if their relative meets the criteria, they will qualify for CHC Funding. Unfortunately, in our experience, this is very often not the case.

The barriers to getting CHC funding are stacked against you and the bar is set very high.

Farley Dwek Solicitors have a wealth of experience, gained over many years, in dealing with MDTs. We provide skilled advocacy and take the stress on our shoulders. We use specialist nurses who have all worked in this particular field for many years, and who understand the National Framework and know how to fight your corner. Farley Dwek can help you at every stage of the assessment or appeals process.

Get our Free Guide or call us on 0161 272 522 or 0800 011 4136 for initial free advice.

For further reading, we recommend that you look at:

Practice Guidance Note 21 of the National Framework: What are the elements of a good multidisciplinary assessment of needs?