Written evidence from Nikki Ensor

Concerns re CHC process  from perspective of a professional and as a family member

DST- Decision support Tool

NST- National Framework for CHC & FNC 2012

MDT-Multi Disciplinary Team

CHC– Continuing Health Care

FNC- Funded Nursing Care

NMC- Nursing & Midwifery Council

• CHC nurses are not following National framework CHC & FNC 2012 and are acting as decision maker rather than that of the coordinator and coordinating the MDT throughout the DST/MDT and making the final recommendation
• CHC Nurses Not formally ‘assessing’ the individual before attending the MDT and having an opinion despite not ever meeting the person before. May meet the individual for 5 minutes before MDT/DST does this make then knowledgeable and familiar.
• CHC nurses not bringing along or sharing  copies of previous DST’s by where eligibility has been met in order measure against for any significant changes
• CHC nurses not recording all information discussed and selectively recording information in order to ensure an individual does not meet eligibility
• CHC nurses not sending a copy of the final draft of DST for MDT to proof read in order to ensure evidence has been  recorded despite this being asked for at MDT/DST.
• CHC not sending copy of final draft DST to MDT or family
• CHC nurses asking MDT to sign DST before it has been completed or even shared to proof read- this would be like signing a blank cheque……………..
• CHC nurses not writing DST within timely fashion or within NMC guidelines for record keeping.
• CHC nurses refusing to move to higher level domains if MDT disagree with CHC recommendation despite giving evidence to prove and justify this
• CHC nurses staring at MDT members to try and intimidate in order to ensure MDT back down and can be hostile and aggressive
• CHC nurses not inviting MDT members to MDT. This means the Local Authority act as coordinator to ensure all MDT are present- ? why do they do this? Lack of MDT allows CHC to have more control?
• CHC nurses bringing along another CHC nurse ( same discipline)  with them rather than an alternative MDT member or alternative discipline in order to overpower MDT
• CHC nurses directly lying when MDT members disagree with them stating MDT are being aggressive rather than challenging professional opinion
• CHC nurses turning up to look through individual being assessed notes either 20 minutes before MDT or at same time  as commencement of MDT and then acting as MDT member rather than co-ordinator.
• CHC Nurses acting as decision maker for final decision re recommendation
• CHC nurses being rude to family members who have disagreed with them during MDT- ‘oh well if you think you know it all and you are being cocky then I might as well leave when advised she has not assessed family member and had only just turned up’- direct quote from CHC nurse to family member
• CHC nurses  not obtaining copies of MDT  reports or assessments
• CHC nurses not writing DST on day of MDT/DST and then sending final draft with date of DST this can be several months later before it is received and therefore it has not been written on day of DST
• CHC nurses attending reviews, not bringing along copies of previous DST where edibility has been met and then advising no longer meets CHC and then advise MDT that they don’t need to complete new DST as DST has just been completed at review- this is not the process as the MDT may not have had the opportunity to have yet formally assess and therefore should arrange a formal DST with MDT whom are knowledgeable and familiar of the individual.
• CHC inviting MDT to DST and they may not be knowledgeable or familiar of the individual and therefore individual does not meet CHC due to lack of anyone knowing them
• CHC nurses directing omitting information which is evidence given at MDT once DST is finally sent to MDT this may be after it has been sent to CCG for ratification then causing further delays as needs to be disputed or appealed
• CHC nurses refusing to record evidence supplied by MDT
• CHC not arranging interpreters or advocate and expecting local authority to do this however not communicating this to MDT
• CHC nurses turning up ‘blind’ to complete DST/ MDT
• Lack of nursing assessments eve given or completed by CHC
• CHC nurses acting as gate keeper rather than seeing the person as a whole
• CHC nurses refusing to request additional information from MDT if it is advised it is required CHC Nurses simply advise’ if it’s not there then it’s not happening’
• CHC nurses intentionally down playing well managed needs in order to not meet CHC

Nikki Ensor

I am an OT working for a Local Authority and also attend many DST’s and support the Social workers in understanding the NSF CHC & FNC 2012.

I have also had the unfortunate experience of attending a DST as a family member  where the CHC nurses acted as decision maker rather  than coordinating the MDT and refused to consider using information from the last several months and chose to only accept information from the last 2 weeks. When this was disagreed with CHC nurse became rude and unprofessional.