Who is on a Multi-disciplinary Team?

The multi-disciplinary team: “A  team  of  at  least  two  professionals,  usually  from  both  the  health  and  the  social  care disciplines. It does not refer only to an existing multidisciplinary team, such as an ongoing team based in a hospital ward. It should include those who have an up-to-date knowledge of the individual’s needs, potential and aspirations.”
(National Framework Glossary)

The MDT or multi-disciplinary team is the group of healthcare or social care professionals who will complete the DST (Decision Support Tool). They are the ones who make the recommendation as to whether the person is eligible or not eligible for CHC funding, and in most circumtsances, that recommendation must be followed by the CCG when they come to make the final decision. (see below for the “exceptional circumstances” in which the recommendation might not be followed)

The Practice Guidance sets out what a MDT is:

PG 30 What is a multidisciplinary team in the context  of NHS continuing healthcare?

30.1   ‘Multidisciplinary team’ (MDT) has many meanings but in the context of NHS continuing healthcare the Standing Rules Regulations define a ‘multidisciplinary team’ as:

‘(i) two professionals who are from different healthcare professions, or

(ii) one professional who is from a healthcare profession and one person who is responsible for assessing individuals for community care services under section 47 of the National Health Service and Community Care Act 1990’.

30.2   Whilst  as  a  minimum  requirement  an  MDT  can  comprise  two  professionals  from different healthcare professions, the Framework makes it clear that the MDT should usually include both health and social care professionals, who are knowledgeable about the individual’s health and social care needs.

30.5    MDT members could include:

•   nurse assessors

•   social care practitioners

•   physiotherapists

•   occupational therapists

•   dieticians/nutritionists

•   GPs/consultants/other medical practitioners

•   community psychiatric nurses

•   ward nurses

•   care home/support provider staff

•   community nurses

•   specialist nurses

•   community matrons

•   discharge nurses.

This list is not exhaustive but is intended as a prompt of who may need to be invited to provide   evidence   regarding   an   individual’s   needs   so   that   as   accurate   and comprehensive picture as possible can be made.

PG 31 What  happens  if  the coordinator is  unable  to  engage  relevant  professionals to attend an MDT meeting?

31.1   CCGs   should   not   make   decisions   on   eligibility   in   the   absence   of   an   MDT recommendation, unless exceptional circumstances require an urgent decision to be made.

The National Framework says:

40.       To minimise variation in interpretation of  these principles, and to inform consistent decision-making, we have, in conjunction with stakeholders, developed the national Decision Support Tool (DST). The DST supports practitioners in identifying the individual’s needs, which, combined with the practitioners’ skills, knowledge and professional judgement, should enable them to apply the primary health need test in practice, in a way that is consistent with the limits on what can lawfully be provided by an LA, in accordance with the Coughlan and the Grogan judgements.

NF paragraph  41.       Further details about the DST and its application are set out below (paragraphs 77 – 89) and in the notes accompanying the tool. Before using the DST, practitioners should ensure that they have obtained evidence from all the necessary assessments (comprehensive and specialist), in line with the core values and principles outlined below.

87.    The multidisciplinary team should use the Decision Support Tool to set out the evidence and enable them to consider not just the overall needs, but also the interaction between the needs, and evidence from relevant risk assessments.

89.    Once   the   multidisciplinary   team   has   reached   agreement,   it   should   make   a recommendation to the Board or a CCG on eligibility.

92.   The CCG may ask a multidisciplinary team to carry out further work on a Decision Support Tool if it is not completed fully or if there is a significant lack of consistency between the evidence recorded in the Decision Support Tool and the recommendation made. However, the CCG should not refer a case back, or decide not to accept a recommendation, simply because the multidisciplinary team has made a recommendation that differs from the one that those who are involved in making the final decision would have made, based on the same evidence.

93.   CCGs should not make decisions in the absence of recommendations on eligibility from the multidisciplinary team, except where exceptional circumstances require an urgent decision to be made. The final eligibility decision should be independent of budgetary constraints, and finance officers should not be part of a decision-making panel.

94.    As part of their responsibility to ensure consistent application of the National Framework, a CCG may review the pattern of recommendations made by multidisciplinary teams, in order to improve practice. However, this should be carried out separately from the approval of recommendations in individual cases.

Decision Support Tool The DST notes say:

(vii)   The DST should be completed by a multidisciplinary team, following a comprehensive multidisciplinary assessment of an individual’s health and social care needs and their desired outcomes. The DST is not an assessment in itself.

(ix)    The DST asks multidisciplinary teams (MDTs) to set out the individual’s needs in relation to 12 care domains. Each domain is broken down into a number of levels, each of which is carefully described. For each domain MDTs are asked to identify which level description most closely matches the individual’s needs.

(x)     MDTs are then asked to make a recommendation as to whether the individual should be entitled to NHS continuing healthcare. This should take into account the range and  levels of need recorded in the DST and what this tells them about whether the individual has a primary health need. This should include consideration of the nature, intensity, complexity or unpredictability of the individual’s needs. Each of these characteristics may, in combination or alone, demonstrate a primary health need, because of the quality and/or quantity of care required to meet the individual’s needs.

Process

  1. Once an individual has been referred for a full assessment for NHS continuing healthcare (by use of the Checklist or, if this is not used in an individual case, by direct referral for a full assessment for NHS continuing healthcare) then, irrespective of the individual’s setting, the CCG has responsibility for coordinating the whole process until the decision about funding has been made and a care plan has been agreed. The CCG should identify an individual, or individuals, to carry out this coordination role. The coordinator may be a CCG member of staff or may be from an external organisation by mutual agreement.
  2. The coordinator should identify the appropriate individuals to comprise the multidisciplinary team (MDT) and liaise with them to complete the DST. This involves matching, as far as possible, the extent and type of the individual’s specific needs with the descriptions in the DST that most closely relate to them. This approach should build up a detailed analysis of needs and provide the evidence to inform the decision regarding eligibility.

Practice Guidance Notes

PG 41 What are the ‘exceptional circumstances’ under  which  a CCG or panel might  not accept  an MDT recommendation regarding eligibility  for  NHS continuing healthcare?

41.1   Eligibility  recommendations  must  be  led  by  the  practitioners  who  have  met  and assessed the individual. Exceptional circumstances where these recommendations may not be accepted by a CCG include:

•     where the DST is not completed fully (including where there is no recommendation)

•     where there are significant gaps in evidence to support the recommendation

•     where   there    is    a    obvious   mismatch    between   evidence   provided   and   the recommendation made

•     where the recommendation would result in either authority acting unlawfully.

41.2   In such cases the matter should be sent back to the MDT with a full explanation of  the relevant matters to be addressed. Where there is an urgent need for care/support to be provided, the CCG (and LA where relevant) should make appropriate interim arrangements without delay. Ultimately responsibility for the eligibility decision rests with the CCG.

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