The NHS is under an obligation to undertake a Continuing Healthcare assessment which will determine whether 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 your relative is already in a care home, or else is about to go into a care setting for the first time (perhaps following discharge from hospital), or being cared for in their own home, they are entitled to request that the NHS undertake an initial Checklist assessment. The Checklist assessment is a useful preliminary ‘screening’ tool to see whether an individual would, in fact, trigger for the second stage – a Full Assessment for NHS Continuing Healthcare at a Multi-Disciplinary Team meeting.
Anyone can ask for a Checklist assessment to be carried out. Speak to a health professional, your GP, hospital doctor, social worker, care provider or care home to request a Checklist assessment.
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 and it can take place wherever they are currently living – whether in a care facility or even in their own home.
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 i.e when the individual returns to their own pre-hospital admission environment (e.g. back in their own home or back to the care home) as an acute hospital setting might not accurately reflect their longer-term needs. If the individual is discharged from hospital to a care home for the first time, a Checklist should be completed once a settling in period has passed.
In the meantime, an interim package of care should be put in place whilst waiting for the Checklist assessment to ensure that there is no gap in your relative’s healthcare requirements.
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. The NHS Framework recommends that where this is the case, any assessment of your relative’s eligibility for NHS Continuing Healthcare Funding should be deferred until the package of support measures has taken effect, to determine whether this improves their long-term prognosis.
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
The Checklist can be completed by a variety of health and social care practitioners, who have been trained in its use, including, for example: a registered nurse employed by the NHS, GPs, other clinicians or local authority staff (such as social workers, care managers or social care assistants).
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 outcome of the Checklist depends on the aggregate number of A’s, B’s, and C’s scored. Generally speaking, in order for the CCG to consider doing a comprehensive Full Assessment, you have to have a minimum ‘score’ in the Checklist:
- 2 or more ‘A’s
- 5 or more ‘B’s (or 1 A and 4 Bs)
- or at least 1 A in a domain with an asterisk*
The Checklist threshold to proceed to a Full Assessment has been set at a deliberately low level in order to enable all those who require a Full Assessment for eligibility to have that opportunity.
Once the assessment is completed, your relative must be given a written copy of the Checklist outcome. 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 still be given information about the process to challenge the outcome of the Checklist.
If your relative agrees that their needs do not meet the necessary criteria for NHS Continuing Healthcare Funding, they 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, it will form the baseline for any future assessments. Knowing your relative’s score and the areas in which they have healthcare needs, means that you have a starting point to compare any deterioration of their condition over time. You can refer to the Checklist as the basis to request a reassessment.
In some circumstances, your relative’s healthcare needs will be so obvious that a Checklist assessment is not required, and the NHS will 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 of your relative’s entitlement to NHS Continuing Healthcare Funding is undertaken.
We have produced a Care Funding Guide to help you understand how the process works which you can download for FREE.
However, our clients often tell us that this is a difficult, emotionally draining, complex and daunting process, which is why we have developed our Clinical Review Service and can provide you with a unique combination of robust legal and clinical expertise, to support you throughout the assessment process.