Some very interesting points.
I totally agree that the £109 nursing care contribution is a drop in the ocean compared to nursing home fees, and in fact the previous system (pre 2007 I think) of three levels of this did in fact reflect nursing need more fairly than the current fixed amount, and more like your 'sliding scale' idea. However, I doubt if the NHS would return to this, having got rid of it. And I don't think social services should share the costs if they are essentially the NHS' remit.
Indeed, the fact that the NHS award this contribution to some patients (as opposed to others who may not even be eligible for this) is in itself an admission that the patient needs some nursing care. So really, if the law were being followed as it should, there should not even be this financial compromise. It should be either NHS (CHC) OR social services - with nothing from the NHS. That is what the 1948 Act said in what is known as the section 21 boundary. It recognised that needs might overlap, but said that where they do, they are the responsibility of the NHS, and not social services who by law are restricted as to the upper limit of what they can provide. The nursing care contribution came in after Coughlan, and that judgement said the NHS were wholly responsible for all her care - not just £100 a week!
You say that mathematical scoring may still be open to interpretation, which could be true in some of the more nebulous domains such as Behaviour etc. - but it wouldn't be any worse than the current way either! I think, though, the domain scoring is not the major problem. Where contention lies is the way the totality of the various scores result in eligibility or not. Apart from 1 Priority/2 Severes, these are far too vague and open to interpretation, and require the addition of 'unpredictability' etc to be used. These cannot really be measured, and should have no place anyway bearing Coughlan in mind. They are essentially a sort of 'trump card' for the CCGs to use when eligibiity is borderline!
Given that 2 Severes = 1 Priority, one could say that 2 Highs = 1 severe, and 2 moderates=1 High. Lets say a Priority were given 16 'points', Severe would be 8, High =4, Moderate=2, and Low=1. Someone with 2 Severes (2 x 8 points) would also be eligible - as they are now. The difference would be that so too would be someone with other combinations e.g. 1 Severe and 2 Highs (8 + 2x4) ; 1 Severe and 4 moderates (8 + 4x2); 4 Highs (4 x 4) etc. People with AD would be more likely to be deemed eligible.
Pamela Coughlan herself was not, of course, assessed using the DST, as it came into existence after her Appeal. However, if she or someone of her exact same needs were assessed on it, they would not in fact score any Severes, but just a combination of 'Highs' and 'Moderates', and with no particular complexity or unpredictability.
Under the present system they would be very unlikely to qualify!!!!
Under the point scoring system, they would - as they should!
Fair and transparent as it is, I can't see the NHS adopting it. Too many people would qualify.
PS - This mathematical scoring would also help ensure LAs are not unlawfully taking on NHS responsibility. At present ADASS recommends their upper limit to be 'about 2 Highs + 3 Moderates'. If the 'scoring' method is to be considered valid, then it should reflect that - and it does! 2 Highs and 3 Moderates are 2x4 + 3x2 = 14. In other words, below the 16 required for CHC. So it works!
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