How is Continuing Healthcare assessed?
The main guidelines for NHS Continuing Healthcare – The National Framework guidelines – on page 25, paragraph 70, state:
“Standing Rules Regulations require a CCG [Clinical Commissioning Group] to take reasonable steps to ensure that individuals are assessed for for NHS Continuing Healthcare. in all cases where it appears that there may be a need for such care.”
The assessment process
The assessment process generally starts with a Checklist, and you can read about the various stages of the Continuing Healthcare assessment process here.
The process should ideally begin as soon as a person needs full time care. If it does not, the person risks being means tested and told to pay for care before anyone has explored whether the NHS may have a duty to pay.
If you are already paying care fees – or your relative is in care and already paying – and you believe you may be eligible for Continuing Healthcare, you can ask a health and social care professional or a care home manager to arrange an assessment. It’s important for family members to be involved in the assessment process and to be present at assessments.
If a person has a Checklist assessment carried out in hospital, and is shown to require a full multidisciplinary team assessment, the NHS is required to pay for care until the final funding decision has been made – even if the person is discharged from hospital in the meantime. (See the National Framework guidelines, page 25, paragraph 74.)
NHS Continuing Healthcare funding is available for full time care at home as well as in a care home.
Financial means-testing should never be part of the decision-making process about eligibility for NHS Continuing Healthcare. Budgetary considerations should also not influence eligibility decisions. It’s about your health needs only.
One of the sticking points in many assessments for NHS Continuing Healthcare is the difference between a ‘health’ need and a ‘social’ need. Many of the case histories we receive from families indicate that health needs are sometimes played down in assessments and described as ‘social care’ needs – but this means the person needing care is more likely to be means tested. Examples of this were also highlighted in the BBC’s File on 4 report: Continuing Healthcare – The Secret Fund on 18/11/14. If health needs are wrongly defined as social care needs, this could also put the local authority in an unlawful position.
NHS Continuing Healthcare assessment tools (forms)
The NHS uses three main ‘tools’ (forms) to carry out assessments for NHS Continuing Healthcare:
- Checklist – initial screening assessment
- Decision Support Tool (DST) – full assessment
- Fast Track Pathway Tool – for use in emergency cases or in the last stages of life
You can find links to all of these tools/forms – including a link to the revised National Framework for NHS Continuing Healthcare – on this page of the Gov.uk website:
However, these assessment tools are used with what many families feel are punitive eligibility criteria that seem to be designed to make it very difficult to qualify for NHS funding. It’s vital to keep the Coughlan case in mind and the local authority legal limit.
Are you eligible for NHS Continuing Care?
The Checklist and the Decision Support Tool record health and care needs in 11 different categories, called care ‘domains’. These are: Behaviour, Cognition, Psychological & Emotional needs, Communication, Mobility, Nutrition, Continence, Skin, Breathing, Drugs/Symptom Control, Altered States of Consciousness and (in the full assessment) a 12th domain: Other significant care needs.
Each domain is given a score. If you score enough in the Checklist, you go through to a full assessment with the Decision Support Tool. You’ll find the page references showing the overall scores you need at each stage here.
If you have high enough scores in the full assessment you will qualify for Continuing Care funding. The assessors also consider the nature, complexity, intensity and unpredictability of all health needs – and this is where many families feel things can get very subjective.
Many families who have contacted us about their experiences with Continuing Healthcare report that the assessment process was not open or transparent and that the guidelines were not always followed. There are many pitfalls to be aware of – and many points you often need to argue to get a fair outcome.
Families also tell us that they are now increasingly asking their MPs to intervene to help resolve problems in the assessment process, and a number of MPs have also raised concerns about the process as a whole.
The Parkinson’s UK report, ‘Failing to Care’, also highlights some of the problems.
The little-known fund that can cover complex care costs – BBC article about NHS Continuing Healthcare
Solicitor Simon Stone from Kingsley David Solicitors sums up so clearly how many people feel about the whole Continuing Care system:
“We use language to twist and wring-out the meaning [in the guidelines], leaving those in need, in need – desperate and knowing the injustice of a sophisticated, free country labelled ‘civilised.’ What gets me more than anything else is that at the high level of our national politics the principles are often, if not usually, sound – but once the grey suits get in, the sinister wringing-out takes over. Free care becomes less care becomes careless.” Simon Stone, solicitor and senior partner at Kingsley David
“We had so little time to put together our appeal for NHS funding, but the information you sent us meant we arrived at the meeting well-prepared and ready to put our case. Thank you so much. I know we couldn’t have won without your help.” Janet Spooner