Follow the links below for the NHS Continuing Healthcare assessment guidelines
You may be wondering what Continuing Healthcare assessment guidelines should be followed when your relative is assessed.
There are various forms and documents that you may come across when going through this process. We’ve highlighted the main ones here. We’ve also included links to a couple of articles that may help you.
Although some of these documents are quite long, it’s worth reading them so that you can identify what is and isn’t being done correctly by the health and social care professionals involved in your relative’s assessment process.
Stages of assessment and appeal
It may be useful to start with to have a look at the different stages of Continuing Healthcare assessment and appeal. This shows you in what order things are generally done. You also be able to see how the Continuing Healthcare assessment guidelines below fit into that process.
Continuing Healthcare assessment guidelines:
National Framework for NHS Continuing Healthcare
The main guidelines for NHS Continuing Healthcare are called the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. It’s worth reading these to make sure that the assessors looking at your relative’s case abide by the rules.
One of the fundamental principles of a Continuing Healthcare assessment is that the underlying health and care needs are assessed, not the needs as they appear once they’re managed. You’ll find references to managed needs vs. underlying needs on pages 21, 22, 61 and 62 of the National Framework.
Stage one of the assessment process: The Checklist. Have a look at paragraph 21 on pages 7-8 for the ‘scores’ your relative needs to achieve in such an assessment, and look at page 10 onwards for information on how the assessment is scored and the kinds of things that are assessed.
Decision Support Tool – multidisciplinary team assessment
Getting through a Checklist assessment doesn’t mean that your relative qualifies for NHS Continuing Healthcare funding. Instead, it means they go on to stage two of the process, which is the full assessment. A Decision Support Tool (DST) is completed as part of this stage. Remember that this is a supporting document, and the members of the multidisciplinary assessment team (MDT) do not have the power to make the actual funding decision; instead, they make a recommendation, and this is passed to a decision-making panel for the final decision. Have a look at paragraph 31 on pages 14-15 of the DST for the ‘scores’ your relative ideally needs to achieve, and look at page 21 onwards for information on how the assessment is scored and the kinds of things that are assessed.
Be sure, also, to read the section about ‘nature, intensity, complexity and unpredictability’ on page 49; note also: the words ‘single condition’ under Complexity; the words ‘in combination or alone’ in the short paragraph tha follows the bullet points; and the words ‘expected to change’ in the last but one paragraph.
Legal limit for local authority care
In the Continuing Healthcare assessment process the legal limit between local authority (means tested) care and NHS care (not means tested) is paramount. This article highlights the legal limit for local authority care – the limit beyond which a local authority is not allowed to take responsibility for care and beyond which it becomes an NHS funding responsibility. It shows why it’s vital that someone from the local authority attends a full assessment – MDT meeting – where the DST is completed, and why that person should play an active role. Remember, this assessment process is about your relative’s health needs, not their money.
Fast Track Pathway Tool
The Fast Track Pathway Tool is used where a person’s condition is rapidly deteriorating. The person may, at the same time, be entering a terminal phase of life – but note the word ‘may’.
Another document you may find helpful is the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. Have a look at Part 6, which covers NHS Continuing Healthcare. Look in particular at paragraphs 21(2)a, 21(4)b and 21(9). These concern having an assessment done to start with, making sure the individual being assessed (and/or their representative) is fully informed, and NHS responsibilities concerning the Fast Track process. These are all processes that many families report are not carried out as they should be.
The Care and Support (Assessment) Regulations
These regulations make it clear that in a care needs assessment by the local authority (which must take place), the person or people carrying out the assessment must be competent and qualified to assess the specific needs of the person they are assessing. They must also refer a person for NHS Continuing Healthcare funding if they have any reason to believe the person’s care may be beyond the remit of the local authority. Read the Care and Support (Assessment) regulations here – in particular point 7.
The Care Act
What’s your family’s experience in the Continuing Healthcare assessment process?