The NHS is required to undertake a Continuing Healthcare Assessment which will determine whether (you or) your relative is eligible for NHS Continuing Healthcare Funding.
This Assessment is done in two stages.
The first stage is called a Checklist Assessment. If this Assessment is successful, you progress to the second stage, to a Full Assessment – using what is called the Decision Support Tool (DST). There is also a Fast Track Pathway Assessment, for cases relating to acute conditions, often in so called “end of life” scenarios.
The Checklist Assessment should be performed within 14 days of it being requested. (although timescales are rarely met). Your relative can ask for a Checklist Assessment at any time during their care. However, if they are about to be admitted into care, usually after a period in Hospital as a result of illness or a fall for example, the NHS can undertake the Checklist Assessment before they are given the Section 2 Discharge Notice, which is sent to the Local Authority/Social Services to pass their care responsibilities over to them.
However, since the revised NHS National Framework came into effect from 1st October 2018, it is now ‘preferable’ for the Checklist Assessment to be deferred and dealt with after discharge from hospital ie when the individual returns to their own pre-hospital admission environment (eg back in their own home or back at the care home etc) as an acute hospital setting might not accurately reflect their longer term needs. In the meantime, an interim package of care should be put in place whilst waiting for the Checklist Assessment.
However, it’s often the case that after a period of treatment in hospital, that the NHS will provide your relative with an interim package of further support, which may include rehabilitation for example. The NHS Framework recommends that where this is the case, any Assessment of your relative’s NHS Continuing Healthcare Funding eligibility should be deferred until the package of support measures has taken effect, to determine whether this improves their long term prognosis.
The Checklist Assessment
The Checklist Assessment can be carried out by any Healthcare Professional, a hospital doctor, GP, District Nurse etc or a Social Worker, but they must be trained and qualified to do the Assessment.
The Checklist looks at 11 criteria called Care Domains, which are:
- Breathing *
- Skin integrity
- Psychological/Emotional needs
- Behaviour *
- Drugs/Mediation/Symptom Control *
- Altered states of consciousness *
The Assessment is made against your relative’s Healthcare requirements in each of these domains and is scored according to the severity of their needs in each area. A = High Needs, B = Some Needs C = Low Needs
In looking at their health needs, the Assessment takes into account the Nature, Intensity, Complexity and Unpredictability of their needs.
Generally speaking, in order to proceed to the next stage of Assessment, called the Full Assessment including the Decision Support Tool, your relative’s Checklist Assessment will need to score 2 or more A’s, or 5 or more B’s (could be 4 B’s and an A), or one A in any domain with an * (but that’s not always the case).
Once the Assessment is completed, your relative must be given a written copy of the Checklist. The Checklist score may mean that your relative automatically progresses through to the Full Assessment stage. Or their score may mean that they fall short, but they should also be given information about the Appeal process as well.
It may be on reflection after the Checklist Assessment has taken place that you and your relative agree that their care needs are not primarily healthcare needs, which will be the case for many people.
In that situation your relative will move from the care of the NHS into the care of the Local Authority/Social Services.
Nevertheless, once a proper Checklist Assessment has been undertaken, that will form the benchmark or baseline for any future assessments. Knowing your relative’s score and the areas in which they have healthcare needs means that you have a start point to assess any deterioration of their healthcare needs over time, which can then form the basis of a request for re-assessment.
You should be aware that in some circumstances your relative’s healthcare needs will be so obvious that a Checklist Assessment is not required and the NHS advise that your relative is going straight through to a Full Assessment.
How to ensure you are properly assessed
You can of course deal with the NHS yourself to ensure that a proper assessment for your or your relative’s entitlement to NHS Continuing Healthcare Funding is undertaken.
However, our clients often tell us that this is a difficult and daunting process, which is why we have developed our Advisory Service to provide you with legal and clinical expertise to support you through the assessment process.
Have at look at our Advisory Service page for more information about how we can help, or do not hesitate to call us today on 0800 011 4136 or 0161 272 5222 or Contact Us online and we will call you back.