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NHS Continuing Healthcare
Who Sits on the MDT and How the ICB Decides
The people in the room, the recommendation and the decision that follows it
Who assesses, and who decides?
A multidisciplinary team completes the full NHS Continuing Healthcare assessment and makes a recommendation using the Decision Support Tool. The Integrated Care Board is the NHS body responsible for the eligibility decision, the funding and later reviews. The recommendation informs the decision; the ICB makes it.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
Families often assume the people in the assessment meeting make the final decision. They do not. Understanding the split between the team that recommends and the board that decides explains both how to influence the process and where to direct a challenge. This guide describes the system in England. Wales operates its own Continuing NHS Healthcare framework through health boards.
When the MDT and the ICB come in
The sequence runs:
- A positive Checklist triggers the full assessment
- The multidisciplinary team completes the Decision Support Tool and makes a recommendation
- The Integrated Care Board makes the eligibility decision and confirms it in writing
- Eligibility is usually reviewed three months after the initial decision and annually after that
How to prepare
For the assessment meeting:
- Ask in advance who will be on the multidisciplinary team
- Make sure someone in the room knows the person's day-to-day needs
- Ask how the person's own views and the family's views will be recorded
- Ask when the ICB's decision is expected and how it will be communicated
- Keep a note of what was said and by whom
Where people often go wrong
- Assuming the meeting itself is the decision
- Not knowing who was on the team or what they relied on
- Letting the deadline pass quietly: in most standard cases the Framework expects the decision within 28 days of the referral for full assessment
- Accepting a decision letter that does not explain the reasoning
- Assuming the meeting itself is the decision
- Not knowing who was on the team or what they relied on
- Letting the deadline pass quietly: in most standard cases the Framework expects the decision within 28 days of the referral for full assessment
- Accepting a decision letter that does not explain the reasoning
How the recommendation becomes a decision
The multidisciplinary team brings together professionals with knowledge of the person's health and social care needs. Working through the Decision Support Tool, the team records levels of need and makes a recommendation on whether the person has a primary health need.
The Integrated Care Board then makes the eligibility decision. In the ordinary course the ICB is expected to accept the team's recommendation and to explain, in writing, the decision it has made. If the decision is negative, the letter starts the six month window for challenge.
A social work led multidisciplinary practice
Nellie Supports is a social work led multidisciplinary specialist practice working across England and Wales, operating through a permanent, full-time employed team that has completed more than 11,000 assessments. Our NHS Continuing Healthcare work prepares and presents the evidence of need at every stage of the process.
Frequently Asked Questions
Can the family attend the MDT meeting?
The person and their family should be involved and have their views recorded. Ask in advance how the meeting will run and who will be there.
Does the ICB have to follow the recommendation?
The recommendation informs the decision, and in the ordinary course the ICB is expected to accept it. Where it does not, the reasons should be clear, and that reasoning can be examined in a challenge.
How long should the decision take?
In most standard cases the Framework expects the eligibility decision within 28 days of the referral for full assessment. If it is dragging well beyond that without explanation, ask why in writing.
This guide is general information about NHS Continuing Healthcare in England, not legal advice, and does not create a professional relationship. Nellie Supports provides independent social work assessment, evidence and advocacy support. We do not provide regulated legal advice, and where a legal remedy is needed we will say so and support your solicitor's work.