Understanding the "Well-Managed Needs" Principle in NHS Continuing Healthcare Assessments

Understanding the “Well-Managed Needs” Principle in NHS Continuing Healthcare Assessments

by Ridley & Hall in James Urquhart-Burton, NHS Continuing Healthcare posted August 29, 2023.

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If you’ve gone through an NHS Continuing Healthcare assessment, you’ve likely come across the concept of the “well-managed needs” principle. In this article, we’ll delve into what the “well-managed needs” principle entails and how it should be applied within the context of an NHS Continuing Healthcare assessment.

Defining the “Well-Managed Needs” Principle
Key Provisions of the National Framework
Challenges and Observations
Recognising Skill and Future Implications
Final Thoughts
How Ridley & Hall’s NHS Continuing Healthcare Solicitors can help

Defining the “Well-Managed Needs” Principle:

The “well-managed needs” principle emphasises that if a specific area of need is effectively managed by a care provider, it shouldn’t be disregarded or marginalised by eligibility assessors when deciding eligibility for NHS Continuing Healthcare Funding. The Department of Health has provided guidance on this principle over the years, with the latest guidance available in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (May 2022)

Key Provisions of the National Framework:

The National Framework outlines important considerations regarding the “well-managed needs” principle:

“Well-managed needs” should not be dismissed, as they are still valid needs.
Only when effective management permanently reduces or eliminates an ongoing need will it impact NHS Continuing Healthcare eligibility.
Caution is advised when applying the principle, considering the influence of an individual’s environment on their needs.
If a need is “well-managed”, consideration should be given to reflecting needs in other care domains.

Challenges and Observations:

As a solicitor specialising in NHS Continuing Healthcare Funding disputes, I’ve observed instances where assessors do downplay “well-managed needs,” and consequently fail to explore the extent of skilled intervention which is being deployed to manage the need.

For instance, the Behaviour domain exemplifies this complexity. The National Framework’s scenario of successfully managed behaviours presents questions about how to consider them in eligibility decisions. The current Decision Support Tool descriptors often lead to challenges in accurately assessing needs that are well-managed.

The problem isn’t just with the assessors – there is incompatibility between the “well-managed needs” principle and the eligibility criteria itself.

Take for instance an individual whose challenging behaviours are being well-managed through care interventions, such that there are no recorded incidents which indicate a risk to self, others, or property. The National Framework says that these “well-managed needs” should be “recorded and taken into account”, but how exactly should they be considered and what bearing should this have on the overall picture of eligibility? The answer is not clear.

The reality is that assessors will score an individual’s behaviour needs lower than they would if the behaviour wasn’t well-managed and outbursts were prevalent. Assessors will rely on the Decision Support Tool and argue that because the requirement for a severe level of need is challenging behaviours which poses a risk to self, others, or property, they simply cannot make such an award where the behaviours are not presently posing those risks.

In other words, although the National Framework says behavioural needs should not be marginalised on the basis that they are well-managed, conversely the Decision Support Tool encourages assessors to do just that by choosing a lower score.

Recognising Skill and Future Implications:

The skill involved in managing well-controlled needs is often overlooked. Consideration should be given to whether the needs would resurface without the current interventions. For example, an individual receiving care from a carer on a 1:1 basis may result in effective management of behavioural outbursts, but given the continuous and sustained nature of that 1:1 care provision, the argument may instead be that this indicates intensity of need, which along with nature, complexity and unpredictability is a key characteristic of eligibility for NHS Continuing Healthcare.

Final Thoughts

Navigating the “well-managed needs” principle in NHS Continuing Healthcare assessments is a challenge. As eligibility assessors grapple with this concept, it’s important to consider both the current management and the potential consequences of intervention withdrawal. While the criteria may, in places, be contradictory, acknowledging the skill in managing well-controlled needs is essential to ensure fair and accurate assessment and to avoid marginalisation of the individual’s needs.