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.
Read: How To Fast Track The Continuing Healthcare Funding Process
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!
Has your relative been “optimised?” NHS invent more delays to avoid CHC Funding…
What’s your experience with the Checklist process?
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My father in law has been refused a checklist unilaterally by the social worker who carried out a social care assessment whilst he was (and still is) in care having been discharged from Hospital. He is suffering from paranoid schizophrenia and psychosis causing many dangerous incidents to himself and others over the past few years and recently. We were only told about the CHC decision when we received a copy of the assessment. We were not told that a decision about CHC was to be made and were given no opportunity to attend at a time when my father in law was unable to either care for himself or indeed make any decisions at all about anything due to his mental state. We were not given any reasons for this refusal in accordance with the National Framework either orally or in writing. I have written, recorded delivery, to the Director of Adult Care at the appropriate ICB, pointing out that the guidelines have not been followed, and requesting a Checklist. I have also pointed out that the assessment itself must necessarily have been only interim, since there he had not then been assessed by the psychiatrist “in the setting of care” and so there was no medical evidence available. Therefore because the CHC decision was made unilaterally and because he had not been medically assessed, the CHC decision was invalid, and as importantly, since no Checklist had been done, he was not liable to pay for care until one is. His social worker, to whom I have spoken since on the phone, rejected all of this out of hand. I have had no reply to my letter or acknowledgement of it.
Hi Nigel – many thanks for your comments. If you would like to chat this through with us we may be able to help. Please feel free to contact us. 0161 979 0430. Kind regards
My FIL is presently in intermediary care after a six week stay in hospital.He has been assessed as unsafe due to cognitive problems as unsafe to return home. Eg on a visit home he tried to go upstairs with his walker, he continually forgets to use his walker unless prompted and is in danger of a fall. We live in France and have poa and are trying to manage this from here. In a phone call yesterday with a social worker, we were told that from the middle of next week he will be self funding. We said no he hasn’t had a CHC assessment yet. We were informed it was done by hospital 30th Jan. We pointed out we weren’t informed, no one attended representing family on fathers behalf and we’ve had no copy of report. She informed us that she would do a second assessment but it must be in next two days as by the middle next week he will be self funding and that to gain funding you must have a nursing need, which he doesn’t have. She said his memory problems with not taking medication, not using walker, would be well managed by a care home and therefore would not be anyway a qualification towards CHC funding. I do not expect, at this stage, my FIL to qualify. Already though I am angry and feel like battle lines have been drawn. We have told her that we want a CHC checklist done within the framework guidance and that as none can attend within two days a more realistic date needs to be set. We await her reply!
Hi Briony,
Sounds like they are trying to hoodwink you! You say he had an assessment in January? What assessment? Was it a checklist? A checklist is the beginning of the process of CHC. If only a social worker has been involved in your FIL’s case, it sounds very much like CHC aren’t involved at all. You should have received/ or your FIL, written notification that a checklist for CHC had been completed and its outcome. That outcome would have given you the opportunity to appeal the outcome should it have resulted in ineligibility. Had the checklist been positive then a full assessment would have taken place (one assumes by now!) and again the outcome should have been sent to you/your FIL, again with the opportunity to appeal. And you are right to be suspicious that you haven’t been informed or invited to attend.
I’m guessing here, that your FIL’s CHC/CCG aren’t involved at all and it’s just S.S that have taken it upon themselves to deal with your father’s situation.
Your doing the right thing by challenging the social worker, but I wouldn’t assume that your FIL doesn’t qualify for CHC.
His cognitive issues will impact greatly on all other areas of his health, so I would urge you to get in touch with the CCG/CHC for the area he lives and find out exactly what involvement they have had and insist that all documentation relating to your FIL case be forwarded to you immediately! Without a full CHC assessment the social worker is wrong to tell you he has NO NURSING NEEDS! Only the completion of the Decision Support Tool and the Key Indicators will determine whether your FIL has a Primary Health Care Need and hence be entitle to Fully Funded NHS CHC.
Until they do this I would not agree to your father being placed in a nursing/care home. I would insist he remain in “intermediary” care until such time as the process of CHC has taken place and you have had involvement.
Good Luck.
Hi Michelle,
Well according to his records that she checked, when on the phone with us, it was a CHC checklist, carried out when in hospital. That is why we are so cross, no one at all informed us and the know we have POA, he hasn’t got mental capacity so couldn’t have agreed to it. We have asked for a copy. We certainly have told them, when she informed us he will be self funding from the middle of this week that without a CHC checklist being carried out in accordance with the framework this was not up for discussion. Her response was that it had to be done within two days, this knowing we live in France! We emailed, after speaking with his brother in law (80 himself) who is prepared to go along to the CHC which is now being arranged for the middle of this week. Luckily he is on the ball and we have had long discussions about the checklist and he is going along with his nephew. They both see him regularly and knowmore about his current state of health.
We are all aware this is probably a battle lost already.
Hi Ledger,
It all sounds very surreptitious! I’m assuming that you have asked for another checklist to be completed and that your FIL was screened in and there is now going to be an MDT to complete the Decision Support Tool (DST)?
Or, are you still at the Checklist stage? I urge you to read the National Framework for CHC and get the Nephew to do likewise. Without knowing a little more about your FIL’s health it’s difficult to help any further, but I certainly wouldn’t assume the battle is already lost! That’s what they want you to do!
Good Luck!
Confused! National Framework for NHS Continuing Healthcare and Funded Nursing Care, state you are not liable for care home fees between discharge from hospital and full assessment taken place ( told eligible for full assessment). Yet above it reads that you pay for care home fees for this period.
Another detailed well presented article from CTBD that will undoubtedly help those starting out on this process. I would add that CHC/CCG’s when ratifying ineligible checklists often advise patients that they have been judged eligible for FNC…..funded nursing care.
This gives the impression that patients have been granted funding only to realise that it equates to roughly £158 a week and only payable when patients are resident in a nursing home. I know that there is plenty of further information about FNC on this website, but I urge families not to be taken in by FNC. There is a strong argument to be made that if a patient is awarded FNC then they must have significant nursing/health needs that have been recognised at the checklist stage and in my opinion warrant a full MDT/DST.
It is that old red herring! Families made to think they have been made an award, when in actual fact they have been hoodwinked.