Navigating the complexities of long-term healthcare can be daunting, especially when considering the financial implications. For individuals in the UK with significant, ongoing health needs, NHS Continuing Healthcare (NHS CHC) offers a route to fully funded care arranged and paid for by the National Health Service. A crucial initial step in accessing NHS CHC is the NHS Continuing Healthcare Checklist tool. This article serves as your comprehensive guide to understanding this vital tool and how it can help determine your eligibility for NHS CHC.
Understanding NHS Continuing Healthcare
NHS Continuing Healthcare is a package of care provided to adults with complex health needs that have arisen as a result of disability, accident or illness. It is free of charge, unlike social care which is means-tested. Importantly, NHS CHC is not determined by a specific condition or diagnosis, but by the level and nature of your assessed care needs. This care can be provided in various settings outside of a hospital, including your own home or a care home.
The NHS Continuing Healthcare Checklist Tool: Your First Step
The NHS Continuing Healthcare Checklist tool is designed as an initial screening process. It’s used to identify individuals who may be eligible for a full assessment for NHS CHC. Think of it as a filter – it helps to quickly determine whether a person’s needs warrant further, more detailed investigation.
This initial assessment is less detailed than a full assessment and can be completed by a variety of healthcare professionals, including:
- Nurses
- Doctors
- Social Workers
- Other Healthcare Professionals
You should always be informed if you are undergoing a checklist assessment and understand what the process involves.
What Happens During a Checklist Assessment?
The professional completing the checklist will consider your needs across several key areas. While the checklist itself is a relatively short document, it prompts the assessor to think about the intensity, complexity, unpredictability, and nature of your care requirements.
The checklist aims to gather enough information to decide if your needs suggest you might be eligible for NHS CHC and therefore require a full, multidisciplinary assessment.
Outcomes of the Checklist Assessment
There are two possible outcomes from the initial checklist assessment:
- Referral for a Full Assessment: If the checklist indicates that you may have needs that could qualify for NHS CHC, you will be referred for a comprehensive full assessment. It’s vital to understand that referral for a full assessment does not guarantee eligibility for NHS CHC, but it opens the door for a more thorough evaluation.
- No Referral for Full Assessment: If the checklist suggests that your needs are unlikely to meet the threshold for NHS CHC, you will be informed that you are not eligible for a full assessment at this time. You should receive written reasons for this decision and a copy of the completed checklist.
If you are not referred for a full NHS CHC assessment, it is still possible to seek support from your local council. They can assess your needs for social care and discuss potential eligibility for council-funded support. Furthermore, if you have some ongoing health needs, the NHS might still contribute to a “joint package” of care in collaboration with social services.
Moving Beyond the Checklist: The Full NHS CHC Assessment
If the checklist assessment indicates a potential eligibility for NHS CHC, the next step is a full assessment. This is a more in-depth process conducted by a Multidisciplinary Team (MDT).
The MDT comprises at least two professionals from different healthcare disciplines, ideally including individuals already involved in your care from both health and social care backgrounds. They will use a tool called the Decision Support Tool (DST) to guide their comprehensive assessment.
Key Areas Assessed in a Full NHS CHC Assessment
The MDT assessment considers your needs across twelve specific domains, each weighted to reflect its impact on your overall care requirements:
- Breathing: Respiratory needs and support required.
- Nutrition (Food and Drink): Assistance with feeding, dietary needs, and nutritional support.
- Continence: Management of bladder and bowel function.
- Skin (including wounds and ulcers): Skin integrity and wound care needs.
- Mobility: Physical movement, transfers, and assistance with mobility.
- Communication: Ability to express needs and understand communication.
- Psychological and Emotional Needs: Mental health and emotional well-being support.
- Cognition (Understanding): Memory, understanding, and decision-making capacity.
- Behaviour: Challenging or unpredictable behaviours and management strategies.
- Drug Therapies and Medication: Complexity of medication regimes and associated needs.
- Altered States of Consciousness: Fluctuations in awareness and responsiveness.
- Other Significant Care Needs: Any other substantial care needs not covered in the above domains.
Each of these needs is assigned a level of severity: “priority,” “severe,” “high,” “moderate,” “low,” or “no needs.”
Eligibility Criteria Based on the Full Assessment
Eligibility for NHS CHC largely depends on the combination and severity of your needs identified in the full assessment. Generally:
- High Likelihood of Eligibility: Individuals with at least one “priority” need or “severe” needs in at least two domains are usually eligible.
- Possible Eligibility: Eligibility may also be granted for those with a “severe” need in one domain plus other significant needs, or multiple “high” or “moderate” needs.
The MDT takes a holistic view, considering the interaction between different needs, risk assessments, and overall care complexity to determine if NHS CHC is appropriate. Your views and those of your carers are also integral to this process, and you should receive a copy of the decision and clear reasons for the outcome.
Fast-Track Assessment for Urgent Needs
In situations where an individual’s health is rapidly deteriorating and they are nearing the end of life, the NHS continuing healthcare fast-track pathway is available. This accelerated process aims to put a care and support package in place urgently, typically within 48 hours. The focus is on providing timely and appropriate care for individuals with rapidly progressing conditions.
Care and Support Planning After Eligibility
Once deemed eligible for NHS CHC, the next step involves creating a care and support plan tailored to your assessed needs. This plan outlines the specific care required and the setting in which it will be provided. Options can include care at home, residential care, and may involve a Personal Health Budget to offer greater control over your care arrangements. Integrated Care Boards (ICBs), the NHS bodies commissioning local health services, are responsible for working with you to develop this plan, considering your preferences alongside factors like cost-effectiveness and suitability of different care settings.
Regular Reviews of NHS CHC
Eligibility for NHS CHC is not static. Your needs and care package will be reviewed regularly, typically within three months of the initial assessment and at least annually thereafter. These reviews ensure that the current care package continues to meet your evolving needs and that you remain eligible for NHS CHC. Changes in your condition may impact your ongoing eligibility.
What if You Are Not Eligible for NHS CHC?
If you are not eligible for NHS CHC but require nursing care in a registered nursing care home, you may be eligible for NHS-funded nursing care. This means the NHS contributes towards the cost of your nursing care component within the care home, regardless of who pays for the remaining fees.
Seeking Advice and Support
Navigating the NHS CHC process can be intricate. Organisations like Beacon CHC offer free, independent advice and support on NHS continuing healthcare. Their website (Beacon website) and helpline (0345 548 0300) are valuable resources for understanding your rights and navigating the assessment process.
Frequently Asked Questions about NHS Continuing Healthcare Checklist and Assessments
Q: How long should the NHS CHC process take?
ICBs are expected to make an eligibility decision within 28 days of receiving a completed checklist or a request for a full assessment. Unjustifiable delays beyond this timeframe, if you are found eligible, should result in a refund of care costs incurred from day 29 until the decision date.
Q: Can I refuse an NHS CHC assessment?
While you cannot refuse the initial checklist assessment or full assessment itself, your consent is needed to share personal information with third parties (like family or representatives) outside of the direct care team. If you have concerns about the assessment, discuss them with the ICB to understand the process and address any worries.
Q: What if I disagree with the NHS CHC decision?
If you disagree with the outcome of the NHS CHC assessment, you have the right to appeal the decision. Information on the appeals process should be provided with the decision outcome. Seeking advice from organizations like Beacon CHC can be invaluable in understanding your appeal rights and options.
Q: Can I request a reassessment if my needs change?
Yes, if your health needs change significantly, you can request a reassessment of your NHS CHC eligibility. Contact your ICB or care coordinator to initiate this process.
Q: Where can I download the NHS Continuing Healthcare Checklist and Decision Support Tool?
You can download blank copies of both the NHS Continuing Healthcare Needs Checklist and the Decision Support Tool from the GOV.UK website using the links provided in this article and throughout the official NHS guidance.
Conclusion: Empowering You with Information about the Checklist Tool
The NHS Continuing Healthcare checklist tool is your starting point in exploring potential access to fully funded NHS CHC. Understanding its purpose, the assessment process it initiates, and your rights throughout this journey is crucial. This guide aims to equip you with the knowledge to confidently navigate the NHS CHC process and advocate for the care you or your loved one needs. Remember to seek support from independent advice services and always communicate openly with healthcare professionals involved in your care.
