The NHS Continuing Healthcare process is complex, and contains a wealth of terms and phrasing that those who haven’t navigated the process before might not have heard of. In this guide, we look to explain one of those terms – well-managed needs.
In this article, we define a well-managed need, explain how they are assessed when it comes to NHS Continuing Healthcare (CHC), and what to do if those needs are being overlooked.
What is a well‑managed need?
In NHS Continuing Healthcare, a “well-managed need” refers to a health condition or behaviour that is currently controlled or stable due to the ongoing care, medication or interventions being provided.
It’s important to state this early – a well-managed need is still a need. Whilst the proactive care taking place will lessen its severity, it is still a need.
“We often have people asking us whether a well-managed need means someone won’t be eligible for CHC funding, and it’s not the case. That’s why it’s important to always ensure you are properly assessed.”
Adam Cartwright, Advisory Director
A well-managed need is still a need (National Framework guidance)
Under CHC guidance, a need must not be ignored simply because the care is currently effective. As described in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, paragraph 162:
“The decision-making rationale should not marginalise a need just because it is successfully managed: 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.”
Until a need has been either permanently reduced in magnitude or completely removed, and therefore requires little to no management, it should be considered when assessing whether a person qualifies for CHC funding.
Examples of well-managed needs in practice
So, what actually is a well-managed need in everyday life? Below, we list some of the more common examples of well-managed needs in practice:
- An individual who has epilepsy who no longer experiences seizures due to their medication regimen.
- A person with diabetes who is able to keep their blood glucose levels stable with insulin doses, blood sugar checks and diet control.
- A patient with dementia who has behavioural needs, but these are managed through consistent and calm caregiving in a care setting.
These are only three common examples, but there are an endless number of well-managed needs that can contribute to a CHC assessment.
How well-managed needs are assessed in CHC
Well-managed needs are considered ongoing needs, rather than resolved issues, and are therefore assessed and recorded in the Decision Support Tool (DST) like any non well-managed needs.
This means that the Multidisciplinary Team (MDT) must assess the need in full, including:
- Recording the care actions, medication and skills required to keep a condition stable. Special attention is given here for behaviours that are controlled, or physical issues that are managed with a high-level of care
- Evaluating what would happen if support were to be withdrawn, focusing on the potential for the need worsening and becoming more unpredictable
- Assessing the need against the four key indicators – nature, intensity, complexity and unpredictability.
Whether a need is well-managed or not, it should be properly assessed during the CHC funding process to determine eligibility.
What to do if your well-managed needs are being overlooked
Unfortunately, one of the most common issues with the CHC funding assessment process is the misunderstanding and assessment of managed needs. Assessors can often evaluate a person based on their condition with support in place, rather than considering the condition if that care were to be removed – this is a major error.
If you believe that this might have happened in your own case or a family member’s case, then there are steps you can take to ensure the need is properly considered:
- Challenge the argument directly: if it’s claimed that the need doesn’t require assessment as it’s managed, you can challenge this directly. You can do this by quoting the National Framework – “a well-managed need is still a need” – and asking for evidence of reduction if they believe the current care has reduced the level of need
- Request the information in writing: requesting the information in writing can help you determine where key information was overlooked and build your case for an appeal
- Initiate a formal complaint: if an informal challenge does not work, you can lodge a formal complaint with the Integrated Care Board (ICB)
- Seek independent advocacy: if you are finding it hard to speak up, you are legally entitled to advocacy. At Compass CHC, we have worked as independent advocates for our clients going through this situation, and can attend meetings and help challenge decisions with you.
Whilst it can be a common mistake, you should not allow success in managing a condition to keep you from the funding you are eligible for. From a more informal challenge to a formal appeal, there are steps in place to help you get a fair and true assessment.
Key takeaways
- A well-managed need is a health care or behavioural need that is being controlled or stabilised with care, medicine or support
- A well-managed need is still a need, and should be reviewed when a person is assessed for NHS Continuing Healthcare funding
- Well-managed needs can be deprioritised in the Continuing Healthcare process, but this is not correct, and can be challenged.
Effective care should never count against you – a well-managed need is not a lesser need. If you’re unsure whether well‑managed needs have been properly recognised in a CHC assessment, please contact us.
Our dedicated specialists can guide you through the NHS Continuing Healthcare funding process, starting with a free, no-obligation call and initial assessment.
FAQs about well-managed needs
What does “well‑managed need” mean in NHS Continuing Healthcare?
A well-managed need is a health care or behavioural need that is being controlled or stabilised with care, medicine or support. For NHS Continuing Healthcare, this should be assessed like any other need.
Can you be refused CHC because your needs are well managed?
No, you cannot be refused CHC funding because your needs are well managed. If you believe this has happened, you can appeal the decision.
How are well‑managed needs scored in the Decision Support Tool?
Well-managed needs are scored on the level of skill, intervention and monitoring required to keep them under control – just like any other need. The success of management does not mean the need is ignored, and the multidisciplinary team (MDT) should assess the “underlying” need.
What happens if assessors say a need is “no longer present”?
If assessors determine that a previously identified need is no longer present, it triggers a formal process to reduce or stop funding and support. However, if you disagree with this finding and believe that a need is just well-managed, you can request a “mandatory reconsideration” to have the decision reviewed.
Do well‑managed needs count towards a primary health need?
Yes – well-managed needs MUST be counted towards a primary health need when being assessed for NHS Continuing Healthcare funding. Whilst proper care can ensure that the symptoms of that need are lessened, it does not mean it is not there, and therefore it must be considered.
Unsure if you or a loved one qualifies?
If you think you or a loved one may be eligible for CHC funding, don’t delay. We’re here to guide you through every step.
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