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3 words the NHS has redefined

9 February 2016

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 February 9, 2016
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Category Budget, Care, CQC

Anyone with a relative receiving full time care and who has been through an NHS Continuing Healthcare funding assessment will almost certainly have noticed how the language used in assessment notes can be misleading – to say the least.

It seems that NHS Continuing Healthcare assessors are rewriting the dictionary now – and actually changing the meaning of words.

Many families report that assessors’ comments and notes deliberately use words that play down health needs, with the result (of course) that the person being assessed is found ‘ineligible’ for funding.

Not only is this exasperating for families, who are then forced to appeal, but it would seem a sinister and cynical attempt to stop people receiving the NHS care they are entitled to.

Not only do we hear of NHS assessors choosing words to manipulate funding outcomes, but it seems some are now also changing the actual meaning of words and phrases in the English language.

The following are real examples of things that have been said and done in Continuing Care assessments.

3 words to watch out for:

1. ‘Unpredictable’

Usual definition: Not capable of being predicted; changeable.

One of the things Continuing Care assessors look for are health needs and risks that are unpredictable, for example a high risk of falls, aggressive behaviour that could be a danger to the person or to others, a risk of choking, etc. We have recently heard two separate instances of the meaning of this word being completely twisted. In seems that (according to the NHS) if health needs are indeed unpredictable, then that unpredictability is likely to be quite predictable! In other words, care staff know the person’s needs are unpredictable – and so these predictably unpredictable needs don’t count. No problem. No funding. It’s absolutely ludicrous.

2. ‘Incontinent’

Usual definition: Lacking in control over urination and/or defecation.

Here’s another account we heard recently. Someone who is incontinent will usually wear continence pads and yet care staff may also sit that person on the toilet from time to time, just in case they need to go at that point in time. It seems that if a carer does take someone to the toilet, and manages to do this before the person has actually soiled their incontinence pad, a miracle has occurred: the person is declared fully continent! And this is what gets written in the assessment notes. No problem. No funding.

Never mind the fact that regardless of what carers may do, the person still has little or no control over their bladder and/or bowel and still needs intense care to manage that. It’s a hideous abuse of power for assessors to manipulate the meaning like this.

3. ‘Malnutrition’

Usual definition: Lack of adequate nutrition resulting from insufficient food, unbalanced diet or poor absorption of nutrients.

There are various reasons why a person in care may not be able to eat very much and/or is losing weight: Dysphagia and difficulty swallowing is one, severe dementia is another, problems with the small intestine or bowel, certain medication and poor care home food are others.

If a person is malnourished, whatever the reason, this is of course a very serious matter. The care plan and care notes for that person may state that they have just a few spoonfuls of food for a meal – but that (and here’s the crucial thing) they finish those few spoonfuls. Hey presto – they’ve finished their meal! They’ve ‘done really well today’ – and the funding assessment notes will often then conclude that the person has a good appetite. All is well then. No problem. No funding. If it weren’t so serious, it would be laughable.

Budgetary considerations should never be part of Continuing Care assessments

The way these things are done can be quite insidious, because when you’re sitting in an assessment and the people in the room are all nodding that everything’s fine and that your relative doesn’t really have any needs that require NHS funding, it can be so difficult to know what to say on the spot. You know it’s not right, and you may feel stunned by what you’ve heard the assessors say, but what’s happening is just so unbelievable that you often just can’t find the words to argue back – and so you’re left wondering How To Get The NHS To Pay For Care – e-book.

Of course, this behaviour by assessors is completely unacceptable – and it’s no doubt down to budgetary motivations and perhaps some pressure they may find themselves under to deny funding. And yet this should never, ever, be part of an NHS Continuing Healthcare assessment.

The whole situation leaves families angry and exhausted, especially when it’s seems that assessors are hiding behind false officialdom and contrived measures to protect their own budgets.

Have you noticed other instances of words being twisted in assessments to prevent funding being approved?

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