First, read our latest article “Understanding the Checklist Assessment”.
Here’s a quick recap…
The NHS Continuing Healthcare Checklist assessment is the first stage in the NHS Continuing Healthcare funding assessment process and simply determines whether the applicant should move on to a full assessment for NHS Continuing Healthcare funding.
This preliminary assessment stage should be relatively straightforward and quick. It is not intended to be a long drawn-out process. The Checklist screening tool can be completed by any health or social care professional who has been trained in its use. Prior to completing the Checklist, the professional must first ensure that appropriate consent has been obtained from the individual (if they have mental capacity) or their representative (holding Lasting Power of Attorney or else acting in their ‘best interests’).
There are 11 headings called ‘Care Domains i.e healthcare needs that are assessed and each one attracts a score of ‘A’, ‘B’ or ‘C’ (A is the highest, C is the lowest). The professional completing the Checklist will use their subjective judgment to score the appropriate level of need under each Domain. The outcome will determine whether the applicant is screened out of the process or can move on to the next stage and undergo a full assessment to see if they are for CHC funding.
However, many mistakes seem to be made at this Checklist stage by assessors, and it leads to people being screened out and then incorrectly means-tested, having to sell their home to pay for their care.
Check out these 11 common mistakes below…
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 your relative has been told they’re having a financial assessment – or they have been asked about their finances – be sure to tell the assessor that this is entirely inappropriate.
The first thing that should happen is an assessment of care needs, NOT money.
11 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.
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 relative’s care needs before the Checklist assessment has even taken place!
The whole point of the Checklist assessment is to see if there’s any chance they might need NHS Continuing Healthcare funding.
Also, the Checklist is not the actual assessment itself. It’s simply an indicator of whether your relative might be entitled to have a full assessment to determine their eligibility for CHC funding (stage 2). So, unless your relative clearly falls into one of the 6 exceptions where a Checklist isn’t required, you should insist on the Checklist and don’t be fobbed off!
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.
The assessor also has a duty to explain what NHS Continuing Healthcare is about, what happens if your relative meets the eligibility criteria and the need for ongoing reviews etc. If you don’t understand the process or are unsure what happens next, then don’t be afraid to say so!
3. You’re told the Checklist can only be completed in a care home.
This is incorrect. It can be completed in any setting, even in the patient’s own home.
However, if in a hospital setting, the National Framework provides it should only be completed once the “individual’s acute care and treatment has reached the stage where their needs on discharge are clear” ie they are medically or surgically fit for discharge and all acute treatment has been completed. (See Practice Guidance Note 18.1).
Furthermore, Practice Guidance Note 18.4 adds, “Checklists should not be completed too early in an individual’s hospital stay; this could provide an inaccurate portrayal of their needs as the individual could potentially make a further recovery. As far as possible the individual should be ready for safe discharge at the point that a Checklist (if required) is undertaken”.
4. You’re not informed about when it’s taking place and you’re not asked to contribute.
This is manifestly wrong and totally unacceptable! It seems many people are also not told afterwards about the outcome, nor given any paperwork or a copy of the completed Checklist, or even informed how to challenge a negative outcome it they disagree with the Checklist scores. The National Framework Guidelines make it very clear that an individual (or their representative) must be fully informed and involved at every stage of the process.
5. The assessor failed to look at how your relative’s care needs are changing.
Assessors must consider the ‘near future’ – how care needs are anticipated to change over the next few months, and this must be taken into account when scoring the Checklist.
6. The assessor makes your care needs fit the lowest score first.
If you look at pages 9-19 of the NHS Continuing Healthcare Checklist screening tool you’ll see that each Care Domain shows the lowest score (C) first. When completing the screening tool it is important that the assessor considers all the descriptors in each Care Domain. We’ve heard of instances where an assessor will look at the description of the lowest score first 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 which could impact on their prospects of moving on to a full assessment. Be alert and ready to challenge the assessor and question why they have ruled out a higher score.
7. The Clinical Commissioning Group (CCG) throws out the Checklist saying there’s ‘not enough evidence’.
The bar to passing the Checklist assessment has been set deliberately low to ensure that individuals are not screened out of the assessment process prematurely, and so have an opportunity to be assessed for NHS Continuing Healthcare funding.
Much less evidence is needed for the initial Checklist than for a full assessment at the next stage of the assessment process. Paragraph 85 of the National Framework confirms that it is not necessary to provide detailed additional evidence when completing the Checklist and that a brief description of the level of need in each Care Domain and the source of supporting evidence used will suffice – see also paragraphs 97- 99 of the National Framework.
8. Assessors ignore the ‘well-managed needs’ principle.
As in the whole NHS Continuing Healthcare assessment process, assessors must look at the individual’s needs, not just the needs as they appear with care in place at that point in time. This is a very common mistake and leads to many incorrect funding decisions.
For more information, read our blog: Do you really understand the “Well-Managed Needs” argument? – 2018
9. Ignoring the Fast Track process.
The Checklist should only be used if it’s NOT appropriate to use the Fast Track Pathway Tool. The Fast Track process should be carried out quickly for people who are in a period of rapid deterioration and at/or nearing end of life, to ensure that they receive a package of care in a timely manner without having to wait for a full assessment.
10. 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 indicator 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.
No individual who is new to the process i.e has not required a package of care previously, should have to start paying for their own care until CHC has been ruled out.
Alternatively, if an individual is already paying for their own package of care prior to the Checklist screening, then they will usually be expected to continue paying until a decision is made. If CHC is subsequently awarded, they may be entitled to a refund from the Clinical Commissioning Group.
Make sure you read the sections of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Revised October 2018) relating to the Checklist, particularly paragraph 105 which we have copied below for your attention:
“An individual should not be left without appropriate support while they await the outcome of the assessment and decision-making process. A person only becomes eligible for NHS Continuing Healthcare once a decision on eligibility has been made by the CCG. Prior to that decision being made, any existing arrangements for the provision and funding of care should continue, unless there is an urgent need for adjustment. If, at the time of referral for an NHS Continuing Healthcare assessment, the individual is already receiving an ongoing care package (however funded) then those arrangements should continue until the CCG makes its decision on eligibility for NHS Continuing Healthcare, subject to any urgent adjustments needed to meet the changed needs of the individual. In considering such adjustments, local authorities and CCGs should have regard to the limitations of their statutory powers. For details on how refunding arrangements might apply in such situations please refer to annex E.
11. You can’t have a full assessment because we haven’t ‘optimised’ your relative.
This is a more recent ruse introduced by some CCGs to delay moving individuals on to a full assessment even after a positive Checklist outcome!
‘Optimisation’ is an invented term used by some CCGs to artificially insert further healthcare assessments (eg for Dementia) prior to a full assessment. This intervening assessment might lead to the introduction of a new medical regime, which if successful, could result in reduced healthcare needs. The CCG can then argue that, with reduced (or ‘well-managed’) needs, a full assessment is no longer required and instead another Checklist should be undertaken. So, rather than passing automatically onto a full assessment, the individual may have to continue paying for their own care far longer than necessary.
To avoid this retrograde step happening to your relative, if you have a positive Checklist, insist that a full assessment takes place without delay!
What’s your experience with the Checklist process?