Have you had problems getting through the NHS Continuing Healthcare Checklist assessment?
Checkout the 11 common mistakes below…
The NHS Continuing Healthcare Checklist assessment is the first stage in the NHS Continuing Healthcare funding assessment process.
This stage should be relatively straight forward and quick. It should not be a long drawn out assessment, and it can be completed by any health or social care professional who has been trained in it.
There are 11 sections (care ‘domains’) i.e. things that are assessed – and each one attracts a score of A, B or C. (A is the highest, C is the lowest.)
However, many mistakes seem to be made at this stage by assessors, and it leads to people being incorrectly means tested.
If your relative needs full time care, it’s vital for you to read the NHS Continuing Healthcare assessment guidelines, so that you know what should and shouldn’t happen regarding funding.
A financial assessment (means test) is NOT the first thing that should happen, and if you and/or your relative have been told you’re having a financial assessment – or you’ve been asked about your money – be sure to tell that person that this is entirely inappropriate.
The first thing that should happen is an assessment of care needs NOT money.
12 frequent mistakes with the NHS Continuing Healthcare Checklist assessment
The following mistakes are all based on reports received from families:
1. Being told your care needs don’t warrant a Checklist assessment and/or that you can’t have one and/or and that you won’t be eligible.
Any individual can ask for a Checklist assessment and the person asked should then arrange it. If you’re told any one of the above things, it implies that the person telling you has already made up their mind about your care needs before the assessment has even taken place! The whole point of the Checklist is to see if there’s any chance you might need NHS Continuing Healthcare funding. (Note: ‘might need’ as opposed to ‘definitely will need’).
Also, the Checklist is not a complete assessment in itself. Instead it’s simply an indicator of whether you might need to have a full assessment (stage 2).
2. The assessor has no training in NHS Continuing Healthcare and in the use of the assessment forms.
Anyone undertaking an assessment at any stage of the NHS Continuing Healthcare assessment process must be properly trained in it. Don’t be afraid to ask what training the assessor has had in NHS Continuing Healthcare and what knowledge they have of the Care Act and of relevant case law, such as the Coughlan case.
3. You’re told the Checklist can only be completed in a care home.
This is incorrect. It can be completed in any setting. In addition, it must be completed before you’re discharged from hospital.
4. You’re not informed about when it’s taking place and you’re not asked to contribute.
This is just plain wrong. It seems many people are also not told afterwards about the outcome, nor given any paperwork and are not informed how to appeal, should they need to. The guidelines make it very clear that an individual (or their representative) must be fully informed and involved at every stage.
5. The assessor failed to look at how your care needs are changing.
Assessors must look at the ‘near future’ – how care needs will change in the next few months, and this must be taken into account in the scoring.
6. The assessor makes your care needs fit the lowest score first.
If you look at pages 10-18 of the NHS Continuing Healthcare Checklist document you’ll see that each care domain shows the lowest score (C) first. We’ve seen instances where an assessor will look at the description of the lowest score and see that the person’s care needs fit that description – but then fail to look at the higher scores. It means people may be given scores that are too low.
7. The Clinical Commissioning Group (CCG) throws out the Checklist saying there’s ‘not enough evidence’.
The National Framework guidelines make it very clear that a Checklist that “has been completed by an appropriate health or social care professional… should usually be accepted and actioned by CCGs”. (National Framework page 95 paragraph 69.2). Much less evidence is needed for a Checklist (stage 1) than for stage 2 of the assessment process.
8. Assessors ignore the ‘managed needs’ principle.
As in the whole Continuing Healthcare assessment process, assessors must look at underlying needs, not the needs as they appear with care in place. This is a very common mistake, and leads to many incorrect funding decisions.
9. Ignoring the Fast Track process.
The Checklist should only be used if it’s NOT appropriate to use the Fast Track process. The Fast Track should be carried out quickly for people who are in a period of rapid deterioration or at end of life.
10. Assessors try to make your needs fit the Checklist format, even if it’s clear they don’t.
You can go through to stage 2 of the assessment process, even if you don’t ‘pass’ the Checklist.
11. You pass the Checklist and the assessors tell you you’ll have to pay for care until stage 2 is completed.
The NHS Continuing Healthcare Checklist assessment is purely an indictor of whether a person needs a full assessment (stage 2). Therefore, at this point, no decision has been made about who is responsible for paying for care.
For more information on all these points, be sure to read the NHS Continuing Healthcare Checklist document and guidance, pages 5-8.
Make sure you also read the sections of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care relating to the Checklist, including pages 25-27 and page 95.
Be sure also to understand what is meant by mental capacity in relation to consent to having a NHS Continuing Healthcare Checklist assessment. A Mental Capacity Assessment is NOT a general assessment of a person’s mental or cognitive state of health or their general ability to make decisions. Instead, it’s about a person’s ability to make a specific decision about a specific thing right now. Read more here about vital mental capacity assessments.
What’s your experience with the Checklist process?