Confused about Continuing Healthcare and how the assessment process works?
We look here at the beginning of the NHS Continuing Healthcare assessment process – especially for people in hospital.
The reports that hundreds of families have shared with us indicate that the the health and social care authorities often provide misleading information to families about NHS Continuing Healthcare.
In an ideal world, all assessors would be properly trained and would follow all the relevant guidelines and case law when looking at care funding but, sadly, that doesn’t seem to be the case in many instances.
Many people who work in hospitals also often seem unaware of NHS Continuing Healthcare – and the need for proper assessment. If they are aware of it, it often seems that they don’t always understand how it works. It means people needing ongoing care are immediately at a disadvantage, as they get wrongly channelled into means testing and paying pay for their own nursing care.
Getting the NHS Continuing Healthcare assessment process started
The Checklist is the first stage of the NHS Continuing Healthcare funding assessment process. The Checklist document is ‘relatively’ straightforward, just 21 pages and 8 of those pages deal with the 11 care domains and associated scores.
Keep in mind that the Checklist can be completed by just one person (a health or social care professional who understands the process, who understands the reason for the Checklist and who has a good understanding of the nature and extent of the care needs of the person being assessed).
The local authority (e.g. a social worker) has a legal duty under the Care Act to refer a person for a Continuing Healthcare assessment if there is even a small chance the person may be eligible.
So you can ask a social worker to get the process started and arrange for a Checklist assessment. You can also ask a health professional to do the same. You can also ask a care home or care provider to get the process started for you. Ignore any response that tries to fob you off or tell you that it’s ‘not worth it’.
If you are acting on behalf of your relative, you should be involved at every stage and asked for your input. You should also be given sufficient notice of any assessment dates and accurate information about the process, how it works and what the eligibility criteria are.
A Checklist does not involve a multidisciplinary team (MDT) and does not need to go to a Clinical Commissioning Group (CCG) decision-making panel. It goes to the Continuing Healthcare team, which is based at the CCG.
CCGs sometimes outsource the assessment process to a Commissioning Support Unit (CSU), but it is the CCG that retains the decision making responsibility for NHS Continuing Healthcare funding.
A positive outcome in the Checklist (i.e. if the scores are sufficient) does not render someone automatically eligible for NHS Continuing Healthcare funding; it simply means the person goes through to stage two: stage two involves a Multdisciplinary Team (MDT) and the Decision Support Tool form; this stage is often known as the ‘full assessment’ and it is much more involved. Page 15 of the Decision Support Tool highlights guideline criteria for eligibility.
If you disagree with the outcome of the Checklist, you can insist that it is done again or you can also request that your relative goes through to stage two, the full assessment, anyway. See page 25 of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
Many families report that they are not kept informed, that assessments are carried out behind their backs and that they come under immediate and inappropriate pressure to submit to a financial assessment.
The whole purpose of the Continuing Healthcare assessment process is to ascertain who should pay for care; a financial assessment is entirely inappropriate until the Continuing Healthcare assessment process is complete.
The vital role of the local authority
Although the Continuing Healthcare assessment process is managed and carried out by the NHS, a local authority representative or social worker must be involved in the full MDT assessment, as they must look at whether or not your relative’s care and care funding is beyond the legal remit of the local authority.
This principle applies throughout all stages of the Continuing Healthcare assessment process.
It is for this reason that no one can say that your relative has to pay for their own care until the assessment process has been properly carried out – whether that’s ‘just’ the Checklist or whether it’s the full assessment as well. It must all be done properly, and in accordance with case law (including the Coughlan case) and abiding by National Framework guidelines, in order for any legitimate decision to be made.
Means testing is only relevant after an NHS Continuing Healthcare assessment – not before
Forcing a person into means testing before this is done could not only be considered financial abuse, but it may also put the local authority in an unlawful position if the person’s care is actually an NHS responsibility.
The new Care Act places a responsibility on local authorities to look properly at whether a person’s care is beyond the local authority’s legal remit. Read more about how the Care Act can help you.
In the experience of many families, hospitals are where many mistakes are made when it comes to the proper Continuing Healthcare funding assessments prior to hospital discharge. Nursing staff are often unaware that an assessment should be carried out and, under the instruction of the discharge team, may simply prepare a person for discharge before it has been properly established who is paying for ongoing care.
The new Care Act makes it clear that this assessment process should take place prior to discharge from hospital.