Three questions every family should ask the ICB. Five governance questions about who actually checked the assessment. Free to use. No catch.
From someone who sat on the other side of the table. Send these questions to the ICB in writing. Request a response within 20 working days.
The National Framework sets out mandatory requirements for how every assessment must be conducted, who must be present, how evidence must be recorded, how domain levels must be determined, and how the final recommendation must be made. A decision reached without following these requirements can be challenged on procedural grounds, regardless of the clinical outcome.
"Please confirm which version of the National Framework was applied to this assessment, identify who was present at the Multi-Disciplinary Team meeting and in what professional capacity, and provide the completed Decision Support Tool with all domain level rationales recorded."
The National Framework is explicit: the recommendation must reflect the Multi-Disciplinary Team's collective professional judgement. In practice, DSTs are sometimes returned after the MDT meeting with instructions to change a domain level, not because new evidence has emerged, but because a manager disagrees with the assessor's interpretation. That domain level no longer reflects the MDT's clinical assessment. It reflects a manager's preference. That is a ground for challenge.
"Please confirm whether the domain levels recorded in the final Decision Support Tool reflect the MDT's assessment as recorded during the meeting, and whether any amendments were made to domain levels or the recommendation after the MDT concluded. If so, please state by whom and on what basis."
The MDT panel reviews the completed DST, not the underlying care records. The quality assurance verifier checks for internal consistency, not whether the rationale is accurate against the primary evidence. The panel may reach a decision without a single member having read a care home note, a GP letter, or a specialist report. If the assessor's interpretation is inaccurate or incomplete, the panel will endorse that inaccuracy.
Which documents formed the evidence base · Whether the quality assurance verifier reviewed original care records or only the completed DST · Whether any MDT panel member reviewed original evidence directly · Whether any evidence was requested but unavailable at the time the DST was completed
Submitting these questions will tell you whether there are grounds for a challenge. What you do with the answers, and whether the ICB's responses reveal a procedural failure, requires someone who knows what to look for.
There is no mandatory qualification for the managers who oversee, quality-check, and approve NHS CHC assessments. The questions below are yours to use at no cost.
NHS Continuing Healthcare assessments are conducted by registered nurses with clinical experience relevant to the patient's needs. What the Framework does not adequately address is what happens at the ratification stage, where a clinical manager or quality assurance verifier reviews the completed DST and either approves it or directs changes.
Ask for the job title and clinical background of the individual who ratified the completed DST before the recommendation was finalised, and whether they hold any CHC-specific qualification.
Ask whether the person who quality-checked the DST has experience in the clinical area relevant to your loved one's primary needs, and whether they have personally completed a CHC Decision Support Tool.
Ask whether any domain levels or rationale sections were changed after the MDT concluded, and if so by whom, at whose direction, and on what clinical basis.
Ask whether the person who approved the final recommendation reviewed the original care records and professional reports directly, or relied solely on the assessor's written account in the completed DST.
Ask the ICB to provide its internal policy on the qualifications, training, and clinical experience required for staff in clinical manager or quality assurance ratifier roles within the CHC team.
The five questions above are free. The interpretation guide tells you what the ICB's responses reveal, and how to use them to build the grounds for a formal challenge.
For a family paying £1,500 a week in care fees, £19 is less than two hours of that cost. The return on knowing whether the ICB's response reveals a challengeable procedural failure is, potentially, the full funding package your loved one is entitled to.
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