If you have a friend, patient, client or relative with complex or challenging healthcare needs, they may be eligible for NHS Continuing Healthcare Funding (CHC) – free funded care provided by the NHS to pay for all their assessed healthcare needs. If so, encourage them to seek an initial assessment for CHC to see whether they qualify for this package of free NHS funding.
There is no cost to the assessment and, if eligible, CHC Funding will entitle them to have all their care fees, including the cost of accommodation in a care home or other care facility, paid for in full by the NHS!
Most families we speak to just don’t know that CHC Funding is available or how to access it! From years of experience in this area, that comes as no surprise to us, because CHC Funding isn’t commonly publicised by the NHS in the public domain – presumably to protect budgets.
We are often asked by families how to go about getting an assessment for their relative’s CHC Funding. Well, the process all begins with a simple screening assessment called ‘the Checklist’. However, most families who have never come across CHC before are clueless where to begin, how to get the Checklist organised, or even who to contact to get the ball rolling for an assessment.
Here’s a quick guide to help you get started if you are unfamiliar with the Checklist process.
What is the Checklist?
The Checklist is not the assessment for CHC Funding itself but is a screening tool used to help identify if an individual may need a full assessment by a Multi-Disciplinary Team (MDT). It is the MDT who will then assess the person and make a recommendation to the NHS Integrated Care Board (ICB) as to whether or not they are eligible for CHC. It is the ICB who ultimately make the decision.
The Checklist threshold has been set deliberately low to ensure that all those who may need a full assessment do not miss out.
So, if you fail the Checklist and get a negative outcome, you can assume that your relative’s needs are too low to require a full assessment at this stage.
However, if you think your relative has been incorrectly screened out of the process at the Checklist stage, you can ask the ICB for it to be reconsidered.
Note: a positive Checklist does not indicate that your relative will ultimately be eligible for CHC Funding. It simply means that they will pass on to the next stage and move to a full assessment by an MDT to determine their eligibility for CHC Funding.
When is the Checklist done?
The short answer is wherever there may be a need for CHC Funding!
The Checklist can be done at any time and in any setting but is preferably undertaken where the patient is living e.g. in their own home or care home.
In the past, pre-Covid, if a patient was in hospital, the Checklist was usually done before discharge.
That all changed post-Covid with the government’s introduction of the ‘discharge to assess policy’. In an effort to try and speed up discharge from hospital and free up beds, Checklists were carried out within a matter of weeks once the patient had returned to their community setting, whether back in their own home or a care facility.
Although in certain cases the Checklist can still be undertaken in hospital, that is rare now, as it is contrary to best practice. In line with the updated NHS National Framework for NHS Continuing Healthcare Funding (July 2022), the Checklist should be carried out ”at the right time and location for the individual and when the individual’s ongoing needs are clearer”. The rationale is that premature Checklists undertaken in an acute hospital setting may give a false picture of the patient’s longer-term needs, and so are generally to be avoided until the patient has had a chance to reach a point of recovery, aided by support and rehabilitation, where appropriate.
For more information read our blog:
Read this if your relative is about to be discharged from hospital into care…
Do I need a Checklist?
There are six circumstances where a Checklist is not required, including when:
- It is clear to practitioners working in the health and care system that there is no need for NHS continuing healthcare at this point in time.
- The individual has short-term healthcare needs or is recovering from a temporary condition and has not yet reached their optimum potential.
- It has been agreed by the ICB that the individual should be referred directly for full assessment of eligibility for NHS continuing healthcare.
- If the individual has a rapidly deteriorating condition and may be entering a terminal phase – in these situations the fast-track pathway tool should be used instead of the Checklist.
- An individual is receiving services under section 117 of the Mental Health Act 1983that are meeting all of their assessed needs.
- It has previously been decided that the individual is not eligible for NHS continuing healthcare and it is clear that there has been no change in needs
Who can carry out the Checklist?
The Checklist can be done by a variety of health and social care practitioners such as: registered nurses employed by the NHS, GPs, other clinicians or local authority staff such as social workers, care managers or social care assistants.
Critically, the appointed assessors must have had suitable training in National Framework for Continuing Healthcare and NHS-funded Nursing Care and be familiar carrying out the Checklist.
How to start?
If your relative lives at home, call the local ICB’s NHS Continuing Healthcare Department directly yourself to arrange a Checklist.
Alternatively, contact your relative’s health clinician e.g. community nurse, GP or their social care professional/social worker, and ask them to contact the ICB’s NHS Continuing Healthcare Department to set it up.
If your relative is in a care home or other care facility, then ask the care Care Home Manager to contact the ICB’s NHS Continuing Healthcare Department to get a Checklist arranged instead.
Timescale
The Checklist should be completed within 14 days of it being requested.
Who can attend the Checklist assessment?
The NHS National Framework provides that the Checklist and overall CHC assessment process is to be ‘person centric’ – that means putting the individual at the heart of the process.
If your relative is being assessed, they should, of course, be present. Any other (family) representatives or appointed advocates can be present too. Usually, family members will be acting in their capacity as attorney appointed under a Lasting Power of Attorney or else acting in their relative’s ‘best interests’.
You should be given reasonable notice to attend. We strongly recommend that you attend the Checklist to make sure your relative is properly assessed and that the assessment is carried out professionally, fairly and robustly. If you can’t attend, try and get the Checklist postponed as it is vital that someone who knows your relative well is there to support them and maximise their chances of passing this preliminary screening stage.
For more information read these helpful blogs:
Do you have Power of Attorney to look after a vulnerable relative?
Do you need legal capacity to assist your relative’s claim for NHS funding? Arguing “BEST INTERESTS”.
How is the Checklist completed?
The NHS’s appointed assessors will complete the Checklist based on their assessment of the individual.
Click on this link to see what the NHS Checklist form looks like and guidance notes.
The screening process is designed to be relatively quick and straightforward.
There are 11 Care Domains that are assessed, namely:
- Breathing*
- Nutrition -food and drink
- Continence
- Skin and tissue viability
- Mobility
- Communication
- Psychological & Emotional needs
- Cognition
- Behaviour*
- Drug therapies and medication*
- Altered states of consciousness*
Each have a description as to the level of need and a ‘score’ ranging from A, B or C – where A represents a high level of care need, and C is a low level of care need. The outcome of the Checklist depends on the number of As, Bs, and Cs identified. To move to a full assessment the Checklist needs to have:
- 2 or more As; or
- 5 or more Bs, or 1A and 4Bs; or
- At least 1A in any domain marked with an asterisk (*)
How long does it take to get a decision?
The outcome of the Checklist should be communicated in writing ‘as soon as reasonably practical’.
Again, a positive outcome is not a barometer as to whether your relative will ultimately be found eligible for CHC as that is to be determined at the next stage at the full assessment carried out by the MDT.
Not had the outcome?
We recommend that you chase the ICB after 7 days if you haven’t had the outcome letter.
What are the possible outcomes?
Well, there are only 2 outcomes here:
- A positive Checklist – means referral for a full assessment for NHS Continuing Healthcare by a Multi-Disciplinary Team is necessary; or
- A negative Checklist – means that the individual does not have a need for CHC and, therefore, no referral for full assessment for NHS Continuing Healthcare is necessary.
The outcome letter will include the decision and reasons (usually with a copy of the completed Checklist) together with the complaints process should you remain dissatisfied.
However, there is no requirement for the ICB to review a negative Checklist.
What happens after a positive outcome?
The patient will be referred to a full assessment for CHC.
Search our website for lots of blogs on MDTs that will help explain and get you through the process.
What happens if your relative’s needs change after a negative outcome?
If your relative has been screened out of the CHC process at the Checklist stage but their needs subsequently change, they can apply for a new Checklist to be carried out at any time.
The previous Checklist can provide a useful comparison to identify any changes in complex needs or challenging behaviours. Of course, in some situations (eg a stroke or nasty accident), an individual’s needs can change quite suddenly and place them into one of the exceptions above, enabling them to bypass another Checklist and move straight to a full assessment by an MDT.
Also consider Fast Track Funding if your relative has a “rapidly deteriorating condition that may be entering a terminal phase” in their life, to shortcut the standard assessment process and apply for immediate provision of CHC Funding via the Fast Track Pathway. If successful, CHC Funding for your relative’s care needs should be put in place within 48 hours of assessment.
For further background reading, take a look at these helpful blogs:
Tears within Tiers: Part 1 – The stages of making an application for CHC Funding
Is your relative entitled to free NHS Funding for their care?
Get in touch via our Care To Be Different website if you need help with your relative’s forthcoming Checklist or want us to review or challenge a negative outcome, or send your enquiry to enquiries@caretobedifferent.co.uk or call us on 0161 979 0430.
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I had a checklist carried out in 2016 the clinical commissioning Trust and l had lots of phone calls,about how the DST would be carried out, as l was insistence on the DST was going to be carried out Coughlan compliant.
The the covid pandemic happened and it was nearly 2 years before the DST was to be carried out in my home.
Only 3 sections of the DST were carried out as the nurse Assessor and l disagreed about the scoring in the continent section the nurse assessor ajourned the meeting,and social workers came and went,there was no time that the CCG contacted me,and social services had not given me annual care assessment for 6 years.
Now my new social worker says l need a new checklist done,and l have told her that my DST was started to be carried out,but the nurse ajourned it.
Why has it not been completed???
What is your take on this.