If your relative’s Checklist Assessment is successful, they will progress to a Full Assessment using the Decision Support Tool (DST). The Full Assessment should happen within 28 days of the Checklist Assessment taking place (although these timescales are rarely met).
The Full Assessment is carried out by a Multi-Disciplinary Team (MDT). This team must consist of at least two people, one Healthcare Professional and one Social Services Professional, but may well include more Healthcare Professionals depending on your relative’s condition. A co-ordinator will be appointed to lead the assessment process.
Your relative will be advised when the assessment is taking place and their advocate should be entitled to attend.
Prior to the Full Assessment the MDT are required to review all the relevant medical and care notes in relation to your relative’s needs.
The assessment follows a similar process to the Checklist Assessment and uses the same domains, plus one further domain for “Other” requirements.
Clients often say that these Full Assessment meetings are intimidating and that the MDT often uses tactics to position what’s being said to their own advantage.
The assessment, whilst similar to the Checklist Assessment, uses a different scoring system. Your relative’s needs are assessed as either N= No needs L = Low needs M = Moderate needs P = Priority needs or S = Severe needs
Whilst the scoring system isn’t scientific by any means, generally speaking, your relative should qualify for Continuing Healthcare Funding if they score Severe in any of the * domains, or as Priority in two or more other domains. Having said that, they could still qualify if their scores aren’t as clear cut as this. It’s also worth noting that the NHS Guidelines state that if there is any uncertainty or disagreement within the MDT about what score to allocate, then the higher of the scores should be applied.
Once the Full Assessment has been completed, the report is sent to the CCG in your area, who make the final decision on whether your relative qualifies for NHS Continuing Healthcare Funding or not. It is not the MDT who makes the decision, although they will make a recommendation.
If your relative’s Full Assessment is successful, they will qualify for Continuing Healthcare Funding, and it is then the responsibility of the NHS to pay for 100% of their care.
Your relative should be aware however, that the NHS will undertake another Full Assessment after three months, and again annually – at which point your relative’s funding may be withdrawn. Your relative will be advised when any further Assessments are going to take place, and they and their advocate will have to prepare for the process in exactly the same way.
If you disagree with the decision, the Appeals process must be explained to your relative when they are provided with a copy of the Full Assessment, and you have the right to Appeal the Assessment.
It may be on reflection after the Full 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 some people. In that situation, your relative will move from the care of the NHS into the care of the Local Authority/Social Services.
How to ensure you are properly assessed
You can of course deal with the NHS yourself to ensure that a proper assessment of 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.