Whether eligibility for NHS Continuing Healthcare Funding (CHC) is being considered for a current assessment of a living individual or as part of a retrospective review for past periods of care (including where the individual is deceased), accurate, comprehensive records are essential to ensuring that CHC outcome decisions are robust, fair, and evidence-based.
Why Care Records Are So Important
To prove eligibility for CHC Funding you need to show your relative has a ‘primary health need’.
When carrying out an assessment for CHC, the NHS’ appointed assessors will place heavy reliance on existing daily care records. These records are the primary source of day-to-day evidence of what support is actually required and delivered. They show:
- How often needs arise
- How serious the risks are
- What interventions are needed
- How much skill is required to manage those needs
Of course, those who have experience of a relative in care, will know only too well, that care facilities are generally under-staffed. That creates added pressure on a carer’s workload, often resulting in records not being written up contemporaneously, or fully, if at all, which permeates into erroneous or poor note keeping.
The Risks of Poor Record-Keeping
The risk is that incomplete, inaccurate or vague records can lead to flawed outcome decisions and vital CHC Funding being refused or withdrawn.
Comments in daily care records such as:
- “No change today”
- “Settled”
- “Good day”
- “Ate better today”
may sound reassuring, but they don’t explain what care was required, how long it took, whether risks were present, or what skilled intervention was required, or how staff managed them.
Some computerised records look impressive, often with colourful charts, emojis and tick boxes, but lack substantive and meaningful detail. Others may present an overly (and misleadingly) positive picture of the individual that doesn’t actually reflect what families observe on a daily basis. Brief entries are usually symptomatic of a lack of time, inadequate training, or simply trying to give a good impression about the care being provided.
When records don’t tell the full story, or underplay needs, individuals risk being wrongly refused CHC funding – which can have a huge financial impact and frequently result in having to sell the family home to pay for care.
Essentially, it is in the NHS’s interests to protect funds and find individuals ineligible for CHC funding. So, generally, their appointed assessors will place great weight and reliance on the records – especially if they are flimsy in content. So, they will contend that if it isn’t written down in black and white in the daily care records – then it didn’t happen. Inadequate record keeping affords the assessors an easy opportunity to justify their position. That is why it is vital that families attend assessments, reviews and appeals to supplement the missing evidence and give their first-hand knowledge of the individual’s actual needs which may not be evident from the records.
Read: Understanding NHS Continuing Healthcare Funding: What It Is and the Challenges of Accessing It.
Good record keeping is also essential for tracking any changes in need over time, which can support your claim for CHC, particularly where needs have increased due to more challenging behaviours.
For further reading around the subject: Understanding the Multidisciplinary Team Meeting
Retrospective Reviews: Why Records Are Crucial
In retrospective CHC reviews, decision-makers often rely substantively on written evidence where available. There may be little or no opportunity for the assessors to observe care being performed or speak to the individual or their family representatives in advance.
This means missing, misleading or incomplete records can paint an inaccurate picture of the individual’s needs and be devastating to a good claim for CHC Funding. Families frequently discover that serious needs or incidents were never properly documented (if at all), making eligibility far harder to prove after the event.
When considering eligibility for CHC, a holistic approach is needed looking at the overall picture of overall health needs in conjunction with the 4 key characteristics (nature, intensity, complexity & unpredictability). So, having accurate and fully detailed records is essential to providing an informed picture of healthcare needs. Every detail, however minor, is likely to have some relevance or interconnect across one or more of the 12 care domains. Missing or inaccurate entries may mean that care needs are underplayed leading to lower scores and a poorer outcome.
Virtual Assessments Increase the Pressure on Records
Most CHC assessments at a Multidisciplinary Team Meeting (MDT) now take place remotely, which can place even greater importance on written evidence.
Good care records must clearly show:
- How needs present day to day
- How those needs are met
- How staff respond to risk
- How needs fluctuate over time
If they don’t, the assessment is unlikely to reflect reality.
Legal Duties Around Record-Keeping
Care providers are legally required to keep accurate, up-to-date records pursuant to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Good record keeping is essential not only for CHC Funding decisions, but for safe and effective care.
Records must be:
- Factually accurate
- Completed in a timely manner
- Stored securely
- Accessible when needed
Families have the right to request copies of care records, which should usually be provided within one month under data protection law. However, with staff shortages, this can often be delayed.
What Families Can Do to Protect Their Position
Families and representatives can play an important role in ensuring records reflect their relative’s true position.
Helpful steps include:
- Asking to see care records regularly
- Checking that known incidents are recorded properly
- Making sure care plans match what is actually happening daily and checking for inconsistencies
- Raising concerns quickly if records are missing or misleading
- Keeping your own contemporaneous written records as evidence of your daily observations
Repeated small entries – about appetite, mobility, continence, behaviour, skin care, or breathing, cognition, medication etc. – can build a powerful picture of ongoing need when viewed (holistically) together, as many needs interconnect.
Final Thoughts
Care records are often the strongest evidence in a CHC assessment, as CHC assessors may take the stance that if it isn’t recorded, then there’s no proof it happened. So, do take time to check what’s in the records, and moreover what’s not!
Family representatives who frequently visit relatives in care, are usually best placed to know their relative’s needs, and should seek to actively ask the care home to correct any errors or inaccuracies.
While good documentation doesn’t guarantee a positive outcome, poor or misleading records can seriously undermine a good claim. Ensuring that records accurately reflect daily care needs and the interventions required to manage them, gives decision-makers the best possible foundation on which to reach a fair and robust decision.
If you’re navigating the CHC process and feel unsure about the quality of care records, seeking specialist advice from Farley Dwek Solicitors early can make a crucial difference.
If you have encountered glaring errors in your relative’s care records which have led to poor outcomes, share your experience below and tell others how you dealt with the problem and if you were able to successfully correct the record entries, or how errors impacted your assessment…
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