Well-managed needs are still needs
A common reason families give for a refusal they think is wrong: "they scored her low because the care home manages it well." The national guidance says that is not how it works.
"Well managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need, such that the active management of this need is reduced or no longer required, will this have a bearing on NHS continuing healthcare eligibility."
Decision Support Tool guidance, paragraph 31
What it means in practice
- If behaviour is calm because staff use skilled techniques every day, the need for those techniques is still a need.
- If skin is intact because of turning every two hours and specialist equipment, the need for that care is still a need.
- The question is whether the need has permanently reduced, so that the active care is no longer required, not whether the care is working.
The same principle applies at the checklist stage and at reviews.
How to use it
For each area scored low "because it is managed", list what staff actually do, how often, and what happens without it. The daily notes and care plan usually show this. Then say so in the appeal: see the letter template.
Source
- Decision Support Tool guidance, paragraph 31
- Checklist guidance, paragraph 21